Blood transfusion

Guideline recommendations

See NICE's recommendations on blood transfusion.

The updated recommendations represent a change to current practice with a wider use of tranexamic acid, than the current recommendations, for example, adults having surgery expected to lose more than 500 ml and children having surgery expected to lose more than 10% blood volume:

• Offer tranexamic acid to adults having surgery in an operating theatre if there is any risk of bleeding and the procedure will breach the skin or mucous membranes. [recommendation 1.1.8]
• Consider tranexamic acid for children (aged 1 to 15 years) having surgery in an operating theatre if there is any risk of bleeding and the procedure will breach the skin or mucous membranes. [recommendation 1.1.12]

Financial and capacity resource impact

The key drivers of resource impact are:

• The level of implementation of tranexamic acid use in surgery.
• The estimated number of blood transfusions avoided after tranexamic acid use.
• The estimated reduction in length of stay.
• The resource and time to administer tranexamic acid (assumed to be minimal when provided in theatres).

We expect that the resource impact of this update for:

• any single guideline recommendation in England will be less than £1 million per year (or about £1,700 per 100,000 people in the population, based on a population for England of 57.7 million people) and
• implementing the whole guideline in England will be less than £5 million per year (or about £8,700 per 100,000 people in the population, based on a population in England of 57.7 million people).

This is because the overall incremental cost of treatment is low, and any cost is likely to be offset by savings and benefits provided by reducing the number of blood transfusions.

The recommendations are estimated to be cost saving when more than 13 blood transfusions per 1,000 patients are avoided through the use of tranexamic acid. These savings are based on the number of blood units saved and associated consumables. This estimate does not account for additional benefits such as shorter hospital stays or benefits to staff time associated with a reduction in blood transfusions.

Population covered

The number of people covered by the update in guideline recommendations is uncertain and will vary depending on local practice. It is estimated that there are 105,431 tranexamic acid IV packs currently used in secondary care based on “RX-Info (2025) Define” data however this may include use in other indications.

Key information

Table 1 Key information

About this resource impact summary report

This resource impact summary report accompanies the update to NICE’s guideline on blood transfusion and should be read with it.