Intended for healthcare professionals

Clinical Review

Transfusing blood safely and appropriately

BMJ 2013; 347 doi: (Published 16 July 2013) Cite this as: BMJ 2013;347:f4303

This article has a correction. Please see:

  1. Michael F Murphy, consultant haematologist and professor of blood transfusion medicine 12,
  2. Jonathan H Waters, professor of anesthesiology and bioengineering3,
  3. Erica M Wood, consultant haematologist and associate professor 4,
  4. Mark H Yazer, associate professor of pathology5
  1. 1NHS Blood and Transplant, John Radcliffe Hospital, Oxford OX3 9BQ, UK
  2. 2National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford University Hospitals and University of Oxford
  3. 3Department of Anesthesiology and Bioengineering, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  4. 4Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University and Department of Clinical Haematology, Monash Medical Centre, Melbourne, Vic, Australia
  5. 5Institute for Transfusion Medicine and Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
  1. Correspondence to: M F Murphy mike.murphy{at}

Summary points

  • Use of evidence based guidelines minimises the adverse effects of transfusion and wastage of products, which are donated by volunteers, costly, and sometimes in short supply

  • Consider red cell transfusion only if haemoglobin is 80 g/L or less in haemodynamically stable patients, including asymptomatic patients with cardiovascular disease

  • Patients with platelet counts greater than 50×109/L or an international normalised ratio less than 2.0 can safely undergo invasive procedures without correcting the abnormal laboratory values

  • Use alternative approaches to patient management to reduce or eliminate the need for transfusion

  • The safe and appropriate use of blood is facilitated by the use of information technology throughout the transfusion process

  • Obtain and document informed consent for blood transfusion, including the risks, benefits, and alternatives

Blood transfusion is an essential part of modern healthcare and can be life saving when used appropriately. Blood services worldwide strive to provide a safe supply and work with hospitals to ensure that blood products are readily available for patients. Blood components such as red cells, platelets, fresh frozen plasma, cryoprecipitate, and granulocytes are prepared from whole blood donations or collected by apheresis. Plasma derivatives such as coagulation factor concentrates, immunoglobulins, and albumin are prepared from large pools of plasma under drug manufacturing conditions.

Sources and selection criteria

As well as using our personal reference collections, we searched the Cochrane database (, Clinical Evidence (, Best Practice (, and a library of systematic reviews in transfusion medicine ( The review draws on multiple sources including national guidelines, peer reviewed original research publications including randomised controlled trials, and systematic reviews. Examples include transfusion guidelines from Australia and New Zealand, which were developed from a series of systematic reviews,1 and a special collection of systematic reviews on avoiding unnecessary transfusion in the Cochrane Library.2

The process of getting a unit of …

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