To review the practice and predictors of autologous (AUT) and allogeneic blood transfusion in patients undergoing radical hysterectomy (RH). All patients undergoing RH between April 1, 1991 and March 31, 1995 were identified by the hospital blood bank. Clinical and tumour characteristics were abstracted from the charts of endometrial cancer patients, and amalgamated with our cervical cancer RH database. Pre and post-operative hemoglobin (Hg), the number of units of AUT blood requested, obtained, and transfused, and the number of units of allogeneic blood transfused were obtained from the blood bank records. Forty eight of the 111 patients undergoing RH during the study period predeposited AUT blood. There were no differences in the median age, quetelet index, American Society of Anaesthesiologists classification of physical status, or blood loss between the AUT and non-donors. The tumour size was greater in the AUT donors, and the preoperative Hg was greater in the non donors (p = 0.001, p < 0.04 respectively). Operative time was less in the AUT donors (2.1 hrs vs 2.7 hrs, p < 0.001), and there was a significant difference in the use of the AUT program between the 3 surgeons (0.5%, 68%, p < 0.0001). Despite similar blood loss, 98% and 33% of AUT and non-donors were transfused intra/postop respectively (p < 0.0001). Regression analysis revealed surgeon (p < 0.0001) to be the only predictor of AUT donation. Blood loss was found to be the only predictor of intraoperative/postoperative blood transfusion in the non donor group (p = 0.0006). The utilization of an AUT blood program differs significantly between surgeons. Physicians are more liberal to transfuse AUT than allogeneic blood.