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Blood transfusion begins with collecting whole blood from a donor using a preservative-anticoagulant combination (typically citrate phosphate dextrose or citrate phosphate dextrose adenine-1). The blood is then tested for transfusion-transmitted diseases, separated into its specific components, and then transfused as clinically indicated. This process is known to have both risks and benefits to the patient, and the decision to transfuse must be based on many variables so that the benefits outweigh the risk. Subsequently, the process of patient blood management (PBM) was developed to incorporate an evidence-based, interprofessional approach to blood product administration. This process considers the patient's entire (projected) course and aids the clinician in determining if transfusion is indicated versus the use of alternative care pathways to ensure the best possible outcome for the patient.

To decrease known morbidity and mortality risks, transfusion guidelines based on evidence-based data have been developed. Results demonstrate that these guidelines can lead to fewer transfusions, better patient outcomes, and, concomitantly, cost reductions for hospitals. Guidelines alone cannot ensure these benefits, as they must be accompanied by physician education and clinical consideration. Additionally, many transfusion strategies recommend the transfusion of one unit and checking lab values to assess effectiveness. This minimizes the risk of over-transfusion as well as circulatory overload.

Nurses are critical partners in transfusions. They ensure the blood is the right product at the right time for the right reason and, of course, for the right patient. Without these safeguards, patients are at significantly higher risk of a clinically significant adverse event.