Inclusions and exclusions

This guideline contains recommendations about general principles of blood transfusion, and applies to a range of conditions and different settings. It does not include recommendations relating to specific conditions.

The guideline covers:

the appropriate use of blood components
alternatives to transfusion for surgical patients
ensuring patient safety, including monitoring for transfusion reactions
providing patients with information about transfusion.

This guideline focuses on the general principles of transfusion. To do this, it was necessary to limit the scope by excluding:

patient groups with special transfusion needs, such as fetuses, neonates and children under 1 year old, pregnant women, and patients with haemoglobinopathies.
specialist areas already covered by NICE guidelines, for example, anaemia in chronic kidney disease, upper gastrointestinal bleeding and trauma and massive haemorrhage.
the use and administration of blood products, such as intravenous immunoglobulin, anti‑D and recombinant activated factor VII.
near‑patient testing for haemoglobin concentration and haemostasis.
laboratory procedures relating to the safety and quality of blood, including pre‑transfusion compatibility testing.
the diagnosis of anaemia.
the management of anaemia in medical patients is out of the scope of this guidance, but it is important to note that the correct approach for managing anaemia in medical patients is important for avoiding unnecessary use of blood.

Despite the lack of specific evidence in the paediatric population, a number of the recommendations have been considered applicable to children following extrapolation from evidence in adults. This was considered to be a reasonable approach to provide some guidance for this age group. However, it should be noted that the guidelines do not cover transfusion for neonates and infants less than a year of age due to the difficulties in extrapolating adult evidence to very young children.