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Efficient use of blood is desirable due to increased demand for blood, shortfall in donations, and the risk of mismatch transfusion accidents and transfusion-transmitted infections. We surveyed transfusion practice in three hospitals. Low haemoglobin was a feature in 91% of transfusion requests and is the commonest ‘trigger’ for transfusion. Forty-eight per cent of transfusions were initiated with the aim of restoring haemoglobin to 10 g dL-1. Seventy-three per cent of transfusions were given when the patient's haemoglobin was between 7 and 10 g dL-1. These figures suggest liberal blood use when compared with international practice. Major healthcare resource and patient safety implications result from this. Evidence-based guidelines issued at both local and national levels would be helpful. [ABSTRACT FROM AUTHOR]