The use of blood components per capita, varies widely, even among the populations of countries that have similar levels of health care. This is despite the existence of broadly similar clinic transfusion guidelines in most EU countries. This wide variation may in part be a result of differences in the demographics or patterns of disease in different populations (PMID 7889138, 19210324, 8023386). However a number of studies have shown that, at least for surgical transfusion, much of the variation cannot be explained by these factors. The low blood requirements of some surgical teams may reflect their attention to the many details of patient management that influence the need to transfuse, including the appropriate use of lower haemoglobin thresholds for transfusion, surgical and anaesthetic techniques, avoidance of hypothermia and the use of “blood sparing” technologies.