Introduction — This topic includes links to society and government-sponsored guidelines from selected countries and regions around the world. We will update these links periodically; newer versions of some guidelines may be available on each society's website. Some societies may require users to log in to access their guidelines.
The recommendations in the following guidelines may vary from those that appear in UpToDate topic reviews. Readers who are looking for UpToDate topic reviews should use the UpToDate search box to find the relevant content.
International
●International Society on Haemostasis and Thrombosis (ISTH): Guidance on the use of platelets in regenerative medicine and proposal for a new classification system (2018)
●AABB: Clinical practice guidelines on red blood cell transfusion thresholds and storage (2016)
●AABB: Clinical practice guideline on platelet transfusion (2015)
●World Health Organization (WHO): Blood donor selection – Guidelines on assessing donor suitability for blood donation (2012)
●AABB: Evidence-based practice guidelines for plasma transfusion (2010)
●WHO: Recommendations on screening donated blood for transfusion-transmissible infections (2009)
Canada
●Choosing Wisely Canada: Transfusion Medicine – Four things clinicians and patients should question in perinatal transfusion medicine (2020)
●Choosing Wisely Canada: Transfusion Medicine – Ten things physicians and patients should question (2020)
●Choosing Wisely Canada: Don't routinely transfuse fresh frozen plasma, vitamin K, or platelets to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ligation, or any other minor invasive procedures (2020)
●Choosing Wisely Canada: Don't routinely transfuse red blood cells in hemodynamically stable ICU patients with a hemoglobin concentration greater than 70 g/L (a threshold of 80 g/L may be considered for patients undergoing cardiac or orthopedic surgery and those with active cardiovascular disease) (2020)
●Choosing Wisely Canada: Don't transfuse patients based solely on an arbitrary hemoglobin threshold (2020)
●Choosing Wisely Canada: Don't transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, active coronary disease, heart failure or stroke (2020)
●Choosing Wisely Canada: Don't transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, or if no benefit was perceived from previous transfusions (2020)
●National Advisory Committee on Blood and Blood Products (NAC): Statement on perioperative autologous donation (2018)
●NAC: Statement regarding appropriateness of use of cytomegalovirus (CMV) seronegative versus CMV safe product (updated 2018)
●NAC and Comité consultatif national de médecine transfusionnelle (CCNMT): Recommendations for use of irradiated blood components in Canada (2018)
●NAC: Position paper on utilization and inventory management of Group O Rh(D)-negative red cells (2016)
United States
●Choosing Wisely: Avoid bleeding and reduce transfusion risk by employing antifibrinolytic drugs (2021)
●Society of Thoracic Surgeons (STS)/Society of Cardiovascular Anesthesiologists (SCA)/American Society of ExtraCorporeal Technology (AmSECT)/Society for the Advancement of Blood Management (SABM): Clinical practice guidelines on patient blood management, update (2021)
●American Society of Hematology (ASH): Guidelines for sickle cell disease – Transfusion support (2020)
●Choosing Wisely: Do not order a Type & Crossmatch for patients undergoing procedures that have minimal anticipated blood loss, historically low fraction of transfusion use, and a low transfusion index (ratio of transfused units to patients) (2020)
●Choosing Wisely: Do not transfuse red blood cells as the sole intervention for expansion of circulatory volume unless deemed necessary for patients experiencing severe hemorrhage (2020)
●Children's Oncology Group (COG): Guidance on platelet transfusion for patients with cancer (2019)
●Choosing Wisely: Do not routinely monitor coagulation tests during a course of therapeutic plasma exchange, unless the procedure is performed daily (2018, updated 2019)
●Choosing Wisely: Don't transfuse packed red blood cells (pRBC) for iron deficiency anemia in asymptomatic pediatric patients when there is no evidence of hemodynamic instability or active bleeding (2019)
●Choosing Wisely: Don't transfuse platelets in an asymptomatic (ie, non-bleeding) pediatric patient (eg, aplastic anemia, leukemia, etc), with a platelet count >10,000/mcL unless other signs and/or symptoms for bleeding are present, or if the patient is to undergo an invasive procedure (2019)
●Choosing Wisely: Avoid transfusion, outside of emergencies, when alternative strategies are available as part of informed consent; make discussion of alternatives part of the informed consent process (2018)
●Choosing Wisely: Do not continue simple transfusions in patients with stroke from sickle cell disease who have iron overload, if red blood cell exchange is available (2018)
●Choosing Wisely: Do not routinely continue a series of apheresis procedures without a predefined objective goal, and stop the series if it is apparent that the goal cannot be reached or adverse effects outweigh potential benefits (2018)
●Choosing Wisely: Do not routinely use plasma as replacement fluid for therapeutic plasma exchange unless there is a clear indication to replete a plasma component (2018)
●Choosing Wisely: Don't transfuse more than the minimum of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable patients) (2018)
●Choosing Wisely: Don't transfuse plasma in the absence of active bleeding or significant clinical and laboratory evidence of coagulopathy (2018)
●Choosing Wisely: Don't transfuse plasma to correct a laboratory value; treat the clinical status of the patient (2018)
●American Society of Clinical Oncology (ASCO): Clinical practice guideline on platelet transfusion for patients with cancer, update (2017)
●Choosing Wisely: Don't routinely transfuse stable, asymptomatic hospitalized patients with a hemoglobin level greater than 7 to 8 grams (2016)
●American Society of Anesthesiologists (ASA): Practice guidelines for perioperative blood management (2015)
●Choosing Wisely: Don't perform serial blood counts on clinically stable patients (2014)
●Choosing Wisely: Don't routinely transfuse fresh frozen plasma and platelets prior to abdominal paracentesis or endoscopic variceal band ligation (2014)
●Choosing Wisely: Don't routinely transfuse patients with sickle cell disease (SCD) for chronic anemia or uncomplicated pain crisis without an appropriate clinical indication (2014)
●Choosing Wisely: Don't routinely use blood products to reverse warfarin (2014)
●Choosing Wisely: Don't transfuse more units of blood than absolutely necessary (2014)
●Choosing Wisely: Don't transfuse O negative blood except to O negative patients and in emergencies for women of child bearing potential with unknown blood group (2014)
●Choosing Wisely: Don't transfuse red blood cells for iron deficiency without hemodynamic instability (2014)
●Choosing Wisely: Don't transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 g/dL (2014)
●Choosing Wisely: Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms of active coronary disease, heart failure or stroke (2013)
●Choosing Wisely: Don't administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin of ≥6 g/dL unless symptomatic or hemodynamically unstable (2013)
●Choosing Wisely: Don't transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac in-patients) (2013)
●Eastern Association for Surgery of Trauma (EAST) and Society of Critical Care Medicine (SCCM): Clinical practice guideline on red blood cell transfusion in adult trauma and critical care (2009)
Europe
●European Society of Intensive Care Medicine (ESICM): A clinical practice guideline for transfusion strategies in bleeding critically ill adults (2021)
●European Directorate for the Quality of Medicines & HealthCare (EDQM): Guide to the preparation, use and quality assurance of blood components, 20th edition (2020)
●ESICM: A clinical practice guideline for transfusion strategies in non-bleeding critically ill adults (2020)
●European Association for Cardio-Thoracic Surgery (EACTS)/European Association of Cardiothoracic Anaesthesiology (EACTA): Guidelines on patient blood management for adult cardiac surgery (2017)
●European Society of Anaesthesiology (ESA): Guidelines for the management of severe perioperative bleeding, first update 2016 (published 2017)
United Kingdom
●British Society for Haematology (BSH): Guideline for haematological management of major haemorrhage (2022)
●BSH: Guidelines on the use of irradiated blood components (2020)
●BSH: Guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn (2014, updated 2020)
●National Institute for Health and Care Excellence (NICE): Interventional procedures guidance on platelet-rich plasma injections for knee osteoarthritis (2019)
●BSH: Guidelines on the spectrum of fresh frozen plasma and cryoprecipitate products (2018)
●Choosing Wisely UK: Royal College of Pathologists – Don't give a patient a blood transfusion without informing them about the risks and benefits (although do not delay emergency transfusions) (2018)
●BSH: Guidelines for pre-transfusion compatibility procedures in blood transfusion laboratories (2012, updated 2017)
●BSH: Guideline on the administration of blood components (2017)
●BSH: Guideline for blood grouping and red cell antibody testing in pregnancy (2016)
●BSH: Guidelines for the use of platelet transfusions (2016)
●BSH: Guidelines on red cell transfusion in sickle cell disease – Part I: Principles and laboratory aspects (2016)
●BSH: Guidelines on red cell transfusion in sickle cell disease – Part II: Indications for transfusion (2016)
●BSH: Guidelines on transfusion for fetuses, neonates and older children (2016)
●Choosing Wisely UK: Royal College of Pathologists – Only consider transfusing platelets for patients with chemotherapy-induced thrombocytopenia where the platelet count is <10 x 109/L except when the patient has clinical significant bleeding or will be undergoing a procedure with a high risk of bleeding (2016)
●Choosing Wisely UK: Royal College of Pathologists – Only transfuse O Rh D negative red cells to O Rh D negative patients and in emergencies for females of childbearing potential with unknown blood group (2016)
●Choosing Wisely UK: Royal College of Pathologists – Use restrictive thresholds for patients needing red cell transfusions and give only one unit at a time except when the patient has active bleeding (2016)
●NICE: Quality standard on blood transfusion (2016)
●BSH: Guidelines on the identification and management of pre-operative anaemia (2015)
●BSH: Guideline on the clinical use of apheresis procedures (2015)
●NICE: Guideline on blood transfusion (2015)
●BSH: Guidelines for the specification, implementation and management of information technology (IT) systems in hospital transfusion laboratories (2014)
●BSH: Guidelines for validation and qualification, including change control, for hospital transfusion laboratories (2012, updated 2013)
●Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC): Guidelines for the blood transfusion services in the UK, 8th edition (2013)
●NICE: Interventional procedures guidance on autologous blood injection for plantar fasciitis (2013)
●NICE: Interventional procedures guidance on autologous blood injection for tendinopathy (2013)
●BSH: Guideline on the investigation and management of acute transfusion reactions (2012)
●BSH: Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients (2012)
●NICE: Interventional procedures guidance on intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy (2008)
●BSH: Guidelines for policies on alternatives to allogeneic blood transfusion – Predeposit autologous blood donation and transfusion (2007)
●NICE: Interventional procedures guidance on intraoperative blood cell salvage in obstetrics (2005)
Australia-New Zealand
●National Blood Authority (NBA): Patient blood management guidelines
●Choosing Wisely Australia: Avoid administering packed red blood cells (blood transfusion) to a young healthy patient with a haemoglobin of ≥70 g/L who does not have on-going blood loss, unless the patient is symptomatic or haemodynamically unstable (2017)
●Choosing Wisely Australia: Don't transfuse more units of blood than absolutely necessary, noting that many hospitals have developed policies on indications for transfusion with a view to minimization (2016)
●Choosing Wisely Australia: Transfuse red cells for anaemia only if the haemoglobin concentration is less than 70 gm/L or if the patient is haemodynamically unstable or has significant cardiovascular or respiratory comorbidity (2016)
Japan
●[In Japanese] Japan Society of Transfusion Medicine and Cell Therapy (JSTMCT): Guidelines
