Australian and New Zealand Society of Blood Transfusion

The Australian and New Zealand Society of Blood Transfusion comprises over 400 members from diverse scientific, medical and nursing backgrounds working within the area of blood transfusion and related fields. NB. These recommendations do not apply to emergency situations, severe acute bleeding and acute phase of major trauma resuscitation.


Do not use peri-operative transfusion for otherwise reversible anaemia prior to elective surgery.

Peri-operative transfusions as a means of addressing untreated preoperative anaemia is associated with decreased overall survival rates but not with recurrence free survival. There is some new evidence that these negative associations are due to the clinical circumstances requiring transfusions rather than the transfusions themselves, but this still suggests that it is preferable to identify and manage anaemia prior to surgery.

Supporting evidence

Boshier et al, ‘Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis. Diseases of the esophagus. 2017; 31: 1-10. Doi: 10.1093/dote/dox134.

Cata et al, ‘Impact of anaesthestics, analgesics, and perioperative blood transfusion in paediatric cancer patients: A comprehensive review of the literature’, Anaesthesia and Analgesia. 2019 December; 129(6): 1653-1665. Doi: 10.1213/ANE.0000000000004314.

Connor et al, ‘Peri-operative allogeneic blood transfusion is associated with poor overall survival in advanced epithelial ovarian cancer; potential impact of patient blood management on cancer outcomes’, Gynecologic Oncology. 2018 June; 151: 294-298. Doi:

Dent et al, ‘Competing risks analysis of the association between perioperative blood transfusion and long-term outcomes after resection of colon cancer’, Colorectal Disease. 2020 August; 22(8): 871-884. Doi: Accessed 13/11/2020

Glance et al, ‘Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery’, Anesthesiology. 2011 Feb;114(2):283-92. doi: 10.1097/ALN.0b013e3182054d06.

Iwata et al, ‘Perioperative blood transfusion affects oncologic outcomes after nephrectomy for renal cell carcinoma: A systematic review and meta-analysis, Urologic Oncology. 2019 January; 37: 273-281. Doi:

Nakanishi et al, ‘Long-lasting discussion: Adverse effects of intraoperative blood loss and allogeneic transfusion on prognosis of patients with gastric cancer, World Journal of Gastroenterology. 2019 June 14; 25(22): 2743-2751. Doi: 10.3748/wjg.v25.i22.2743.

How this list was made How this list was made

As part of the Evolve program, the RACP Policy and Advocacy team has worked with the Australian and New Zealand Society of Blood Transfusion (ANZSBT) to develop and finalise this Evolve Top-5 list of low-value care that pertains to the specialty.

Per usual processes, the list of low value practices was first identified by the ANZSBT Council and condensed to the top-5 recommendations, through a membership survey, extensive research and rounds of redrafting under the guidance of the ANZSBT Council. The list was subjected to an extensive review and consultation process that involved RACP-affiliated specialty societies and other key colleges via the Choosing Wisely program. Feedback from the consultation has been integrated into the top-5 recommendations by the ANZSBT and approved by its Council in December 2021.

Version 1 published January 2022.