Anaemia is a common complication of critical illness and 40−50% of all patients in intensive care units (ICUs) receive blood transfusions. However, despite the perceived benefits of correcting anaemia, numerous non−randomised cohort studies and a system review suggest associations between blood transfusions and adverse patient outcomes. The only large randomised controlled trial comparing restrictive with liberal transfusion policies in critically ill patients (the "TRICC study") suggested a trend to greater morality at 30 days in the liberal transfusion group. However the TRICC study does not inform clinical practice with regard to how to manage long stay ICU patients. Also, and importantly, the blood product used in the TRICC study contained white blood cells (non−leucodepleted), which are associated with adverse events, whereas blood in the UK now has the white blood cells removed prior to blood storage (leucodepleted). Due to continuing uncertainty many clinicians continue to use higher Hb transfusion triggers in longer−term ICU patients and we confirmed this recently in a survey of 184 ICU clinicians.