Inappropriate transfusion practices are common in hospitals. Not only does this put significant strains on national blood supplies, but it also exposes patients to potential harm. Risks of unnecessary blood transfusions include allergic, febrile, or haemolytic reactions, transfusion-associated circulatory overload, and acute lung injury.

Choosing Wisely recommendations and international guidance suggest adopting conservative blood use (often referred to as restrictive transfusion practice) in stable, non-bleeding patients. Guidance is available on when to transfuse RBCs in adult inpatient settings.

How should practice change?
Mehta and an international group of clinician and patient coauthors suggest targeted quality improvement strategies, such as audits against evidence-based standards, can be effective in improving transfusion practices in hospitals.