15th March 2022

A 97-year-old woman is brought to A&E via ambulance

A 97-year-old woman is brought to A&E via ambulance. She has been increasingly lethargic over the past few days, and her daughter visited that day to find her drowsy and confused. Her initial blood gas shows a haemoglobin level of 45, which is confirmed by laboratory testing and a significant drop from routine bloods a month previously. The patient is conscious, haemodynamically stable, and slightly muddled although conversing sensibly with you. You explain to the patient and her daughter that she needs an urgent blood transfusion. The daughter takes you aside and produces a letter, seemingly signed by the patient, that she does not wish to receive any blood transfusions.

Which of the following is the best course of action?

Select the SINGLE most appropriate option from the list below. Select ONE option only.