Hysteroscopy - blood transfusion declined

[JudgeDread]

I have a polyp removal scheduled in a few weeks, by way of hysteroscopy under general anaesthetic, and have declined blood transfusion.

I've read the procedure is a minimally invasive procedure and none of the outlined risks of the procedure include loss of blood.

Can anyone share any experience and help me to understand if I've made the correct decision?

Why did you decline it?

You haven't. The risks are small, but if things go wrong and you need a blood transfusion then the risk of not having one far outweighs any possible risk of having a blood transfusion.

Why?

That’s an unwise decision to say the least.

Is it possible for anyone to share their experiences on why it's "unwise" rather than just making the statement?

I appreciate views may differ but I'm looking for life experiences, not theories and debate regarding difference of opinion, and based in reference to this particular procedure.

Many thanks.

Ok, it’s unwise because if for some reason something went wrong and you started haemorrhaging and needed a blood transfusion to save you, that option has been removed. So you are at a higher risk of death / serious complications.

By agreeing to a transfusion, you’ve given the doctors more options if the worst should happen.

Agreeing to a transfusion doesn’t increase the risk of the surgery or the likelihood of you needing a transfusion, but it would give surgeons more options to save you in a worst case scenario.

Do you belong to Jehovahs Witnesses?

Thank you.

The pre-assessment screening and the q'aire and the letter from the consultant did not list blood loss as a possible risk at all. I'm trying to understand if this means there is no risk given the type of procedure. I'm going to see them today for in person assessment so will ask them to clarify.

Are they open to changing their decision based on the degree of risk?

I had a procedure under hysteroscopy just a few weeks ago. I had very low iron stores and anaemia and was due to have fibroid resection, and removal of any polyps if found. I raised the risk of blood loss at my pre op and quoted the CPOC guidelines because i had also been referred for iron infusion and had read about the preference to get iron status corrected BEFORE the procedure. I was told this procedure was considered lower risk compared to "open surgery" and i could have iron infusion afterwards. The anaesthetist was fully aware of my anaemia before the procedure. It all went fine. I didnt have polyps.

Having said that, lower risk doesnt mean no risk. The "serious or frequently occurring risks" on my consent form said infection, bleeding, risk of perforation or injury to internal organs. (I ticked yes to blood transfusion and agreed to repair of any injury).They pump fluid in to the uterus and have to monitor that carefully, instruments used can accidentally pierce the uterus. Ask the team what the risk of blood loss is during polyp removal. If it involves a heated loop, that can seal off blood vessels, that might be lower risk of blood loss. They will go through the consent form with you again before the procedure, so if you change your mind about the transfusion , its fine you can tell them. I found they asked me the same questions over and over, three different people, this was all geared towards my safety (allergies, family medical history).
You can definitely raise any concerns beforehand. I recall the anaesthetist asking if i had any worries
Ive just looked out my consent form (you should have a copy) and it actually says "you have the right to change your mind at any time, including after you have signed this form". So its you that can change the decision!

All the best
Edited for typos

I think before any response can be given that will be meaningful to you we need to know why you've declined the possibility of receiving a transfusion should you require one. Is it that you've some adversion or fear of having someone else's blood in your body? Or do you fear that they will give you a transfusion even if you don't require one? Or is there some religious or ethical reason you refuse blood transfusions? Have you had a bad experience with one? Or is it something else altogether?

Blood loss is a risk from any surgery that involves removing anything. It is definitely a risk in hysteroscopy, even without removal of anything. I bled very heavily during and after.

Refusing a transfusion is a risk to your life. The risk may be low, but the consequence is high. Only you can decide if that’s worth it to you.

Thank you so, so much for sharing your experience! This means so much to me, thank you! I did go into the hospital today to do some pre-assessment checks but wasn't able to ask any questions because I was only there for bloods, weight check etc so you have put my mind at ease by suggesting I have more time to consider even up to the point of the procedure. Thank you again - I really appreciate you! ❤

I've had two of these procedures in the last 18 months and I genuinely don't think I was ever offered a blood transfusion?

But if I was, I wouldn't decline it if the alternative was to bleed to death.

All of the above apart from fear that a transfusion would be given if not needed. I have read a lot of things about new methods, which are comparable or superlative to blood transfusions, and so wanted to ask if the consultant uses those new procedures etc. It's reassuring to know that I have more time to consider my options.

It would likely be standard practice for your medical team to try alternatives to transfusion before giving blood products. You are right that there are risks to transfusions and also blood is a limited resource so you should only get one if it's truly needed.

You haven't been super clear what your precise concerns are, or if you have a higher risk than the average person for having a transfusion reaction. You absolutely don't need to go into it on the Internet but you should be very open and honest with the team doing the procedures about your personal risk factors and concerns and they can help you come to an informed decision.

Bleeding is not super common with a hysteroscopy, but it can happen. One of the risks they’ll likely have mentioned to you is the risk of perforating the uterus. If that happens, you can get damage to the nearby organs (eg bowel, bladder), and to any blood vessels nearby, which would obviously cause bleeding. If a perforation has happened, the team would normally need to do either keyhole or open surgery to check the extent of the perforation and to repair any damage, and one of the main risks of that sort of surgery is bleeding.

Obviously I don’t know anything about your medical history or any individual risk factors you have, but the tick box on the consent is mainly there so that if you did have unexpected, heavy/life-threatening bleeding during your operation, they can give you the treatment you need straight away (because obviously you’d be asleep so unable to consent, so they ask you beforehand). If the bleeding is less heavy then normal practice would be wait to see how you are feeling, what your blood count is etc before recommending a transfusion, and you’d have the option to consent or decline at that point.

I would say it’s pretty unusual to have anyone decline an emergency blood transfusion tbh, unless there are religious considerations. Blood is in short supply, and transfusions are only given if they are really needed, so I would urge you to think very carefully before you decline it. In any case, on the day of your surgery you’ll be able to talk to the surgeon about it and make any final decisions about what you want to do.

Also curious what these new methods are? Do you mean cell salvage?

Hi there, beyond finding out that there are some, I'm not educated enough to know what the precise alternatives are, what they entail or when they would be considered. This is something I am going to question with my consultant. If you're aware of any you think might be of interest to me, so I can educate myself in the interim, I will have a look! Thank you!

No, of course you haven’t made the right decision. Isn’t that just common sense or am I missing something here? You should be fine but god forbid something goes wrong and you need a blood transfusion you’ll die because you’ve declined it. I don’t really understand the point of this post? Stop wasting the consultants time asking bizarre questions and just tick the box for his/her sake as well as your own.

i vaguely recall that the possibility of a ruptured uterus necessitating a hysterectomy was named as a possible risk of a hysteroscopy, but it was one of many things that I had to be aware of prior to signing the consent form. I don't recall a blood transfusion specifically being mentioned.

I was 64 when I had mine done with only a local into the cervix. Things went much more smoothly than I expected - astonishing to me, given my age and the fact that I've never carried a pregnancy beyond the early stages.

I'll add that there was a very small amount of bleeding after the procedure, but all I had to do was to use a sanitary towel. Nothing major at all.

ETA I had a hysteroscopy plus biopsy.

I had one with no bleeding. But if I’d needed a transfusion I’d have accepted one.