Overview
This guideline covers assessing for, and managing, blood transfusions in adults, young people and children aged 1 year and over. It covers the general principles of blood transfusion, but does not make recommendations relating to specific conditions.
This guideline does not cover blood transfusions, or use of tranexamic acid for surgery, during pregnancy and labour. For more information on what the guideline does and does not cover, see the section on inclusions and exclusions.
Some people have religious beliefs that do not allow the transfusion of blood. Specific issues relating to these people have been addressed when reviewing the evidence and writing the recommendations.
For guidance on blood transfusions and anticoagulant reversal for people with acute upper gastrointestinal bleeding, see the section on resuscitation and initial management in NICE’s guideline on acute upper gastrointestinal bleeding in over 16s.
Last reviewed: 26 February 2026
We reviewed the evidence and made new recommendations on using tranexamic acid during surgery.
Next review: This guideline will be reviewed if there is new evidence that is likely to change the recommendations
How we prioritise updating our guidance
Decisions about updating our guidance are made by NICE’s prioritisation board. For more information on the principles and process, see NICE-wide topic prioritisation: the manual.
For information about individual topics, including any decisions affecting this guideline, see the summary table of prioritisation board decisions.
Recommendations
This guideline includes recommendations on:
- reducing requirements for blood transfusion for people having surgery
- red blood cell transfusion
- platelet transfusion
- fresh frozen plasma transfusion
- cryoprecipitate transfusion
- prothrombin complex concentrate transfusion
- patient safety and information
Who is it for?
- Healthcare professionals who assess for and manage blood transfusions and their alternatives
- Commissioners and providers of transfusion services
- People aged 1 year and over who may need a blood transfusion, their families and carers
Guideline development process
How we develop NICE guidelines
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.