Do you have an upcoming surgery, or would you like to learn about the ways physicians can manage your blood during procedures?
Our patient blood management resources and printable materials offer useful information about reducing unnecessary blood transfusions.
Printable Materials: Patient Blood Management
We’ve added some of our informational materials here so you can download, print, and read at your convenience. If you need help talking to your doctor about patient blood management before surgery, print and take them to your appointment.
If you need help talking to your physician about patient blood management before surgery, download and print the PDFs below and take them to your next appointment.
- Release From Liability for Failure to Administer Blood Transfusions Form (RFL) for People Who Decline Transfusions
UPMC is committed to treating patients with dignity. The staff respects individual patient beliefs and practices, including the refusal of blood transfusions. In keeping with this belief, The Center for Bloodless Medicine and Surgery was established to ensure that patients who refuse transfusions are clearly understood and identified.
If you wish to refuse blood and/or blood products for a procedure, hospital stay, etc., please complete this Release From Liability for Failure to Administer Blood Transfusions Form (RFL) and bring it with you. Completing this RFL form includes your signature and the date the form was completed. Your signature must be witnessed. Your witness can be a family member or a friend. They will sign their name as a witness to your signature on the RFL form.
Please call 877-674-7111 with any questions regarding the RFL form.
- Blood Products Wallet Card (PDF): Fill out this printable wallet-sized card to help your doctor understand your wishes by considering in advance the use of various products derived from whole blood, synthetic products, and procedures that use autologous (your own) blood. This checklist may help you to be better prepared for surgery.
- Glossary of Terms and Worksheet for Blood Products and Procedures (PDF): Use this worksheet to record your personal blood choices and to better understand the different blood products and procedures.
- Patient Blood Management (PDF): Do you want to learn more about patient blood management at UPMC? Download our guide to patient blood management. The guide includes a work sheet that can be completed with your doctor when planning for surgery.
- Patient Blood Management: Anemia and Cancer (PDF): Do you receive chemotherapy or radiation therapy as part of your cancer treatment? If so, you may become anemic. Learn what you can do to manage anemia during cancer treatments. Be sure to review our educational flier with your oncologist and/or personal physician.
- Patient Blood Management: Anemia and Pregnancy (PDF): Are you pregnant or thinking about becoming pregnant? Do you want to learn more about what you can do to incorporate patient blood management into your delivery plan? Be sure to read and review our educational flier with your obstetrician.
- Blood Transfusions: What You Need to Know (PDF): Do you have questions about blood transfusions, blood products, the risks, and techniques you can use to reduce your need for blood transfusions during surgery? You can learn about these things and more by reading our educational flier.
- Patient Blood Management: 7 Questions to Ask Your Surgeon (PDF): Each type of surgery and every patient are unique. Your surgeon will explain the risks and help you to evaluate your case. This document includes questions that may be helpful when talking to your surgeon before surgery.
What's New
Heart Transplant Without Blood Transfusion
During a recent virtual seminar, David James Kaczorowski, MD, who specializes in cardiothoracic transplantation, discussed expanded treatment options for heart transplant patients who cannot accept blood transfusions. For details, read the article, “Heart Transplant Without Blood Transfusion.” If you would like to be kept up to date on future seminars, please submit your email address in the “Contact Us” tab.
Now Online: Our Release From Liability (RFL) Form
If you wish to refuse blood and/or blood products for a procedure, hospital stay, etc., you can save time by completing a Release From Liability for Failure to Administer Blood Transfusion Form (RFL) for Patients Who Decline Transfusions (PDF).
Are you pregnant or do you know someone who is?
Bloodless medicine solutions are available for expecting mothers who choose not to receive blood transfusions. Connect with a bloodless medicine advocate early in your pregnancy and learn about available options. Call 877-674-7111 to get started.
