Transfusions should be given for medical indications and based on the clinical context for the individual patient. Clinicians should follow the most current existing clinical guidelines. The neonatal hemostatic system differs significantly from that of children and adults. Still, healthy neonates have a balanced hemostatic system. Since the level of hemoglobin is critical to tissue oxygenation, it is important in the rapidly developing neonate. For preterm neonates, different red blood cell transfusion thresholds should be used based on postnatal age and illness severity. Most hemodynamically stable pediatric intensive care patients with a hemoglobin >70 g/L do not require transfusion. Pediatric massive transfusion protocols should exist in pediatric hospitals. At Karolinska University Hospital, red blood cells, fresh frozen plasma and platelets are transfused in a ratio of 20:20:10 mL/kg to children <50 kg. In liver disease, transfusions can lead to increased bleeding.