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Refusal of blood products — FRCA Final MCQ

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ModerateEthics, Human Factors and Patient SafetyRefusal of blood productsFRCA Final

A Jehovah's Witness patient with capacity is scheduled for major gynaecological surgery. She refuses red cells, plasma and platelets after detailed discussion, but accepts cell salvage and tranexamic acid. Haemoglobin is 112 g/L and the surgeon anticipates significant blood loss. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Document the informed refusal and plan blood conservation strategies

A capacitous adult may refuse blood components even if the decision increases risk of death. The anaesthetic duty is to confirm understanding, document specific acceptable products and plan blood conservation such as optimisation, cell salvage and antifibrinolytics. Relatives cannot overrule a capacitous refusal. Covert transfusion would be unethical and unlawful.

Reference: GMC consent guidance; Association of Anaesthetists blood refusal guidance