Intended for healthcare professionals

Practice Guidelines

Blood transfusion: summary of NICE guidance

BMJ 2015; 351 doi: (Published 18 November 2015) Cite this as: BMJ 2015;351:h5832
  1. Smita Padhi, senior research fellow1,
  2. Sophia Kemmis-Betty, senior health economist1,
  3. Sharangini Rajesh, research fellow1,
  4. Jennifer Hill, operations director1,
  5. Michael F Murphy, professor of transfusion medicine, consultant haematologist2
  6. On behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, London, UK
  2. 2University of Oxford; NHS Blood and Transplant; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to: M F Murphy mike.murphy{at}

What you need to know

  • Consider alternatives to blood transfusion in surgical patients

  • Offer tranexamic acid to adults undergoing surgery who are expected to have at least moderate blood loss (>500 mL). Do not use cell salvage alone without tranexamic acid

  • For patients who need red blood cell transfusions and do not have major haemorrhage or acute coronary syndrome, use a restrictive haemoglobin concentration threshold of 70 g/L and a haemoglobin concentration target of 70-90 g/L after transfusion

  • Consider single unit red blood cell transfusions for patients who do not have active bleeding and reassess patients after each transfusion

Although blood transfusion is common in clinical practice, it is associated with some risk. Alternatives to blood transfusion are also underused.1 Audits in the United Kingdom show that the inappropriate use of blood components is 20% or more.2 This puts patients at unnecessary risk of receiving the wrong blood and of complications such as circulatory overload and transfusion related acute lung injury, as well as wasting a scarce and costly resource. Measures for managing patients without blood transfusion are underused.1

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on blood transfusion.3

What’s new in this guidance

  • Electronic patient identification systems can improve the safety and efficiency of routine transfusion

  • Patients who may have or who have had a transfusion, and their family members or carers, require verbal and written information about transfusion and its alternatives


NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Alternatives to blood transfusion for patients having surgery


  • Offer erythropoietin only if:

    • -The patient has anaemia and meets the criteria …

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