Many of the pediatric transfusion threshold guidelines are derived from clinical trials in adults, retrospective studies in pediatric populations and expert opinions. One of the highest utilization groups in pediatric patients is made up of those who have hypoproliferative thrombocytopenia and anemia secondary to cancer therapy or stem cell transplant. The first speaker will present a review of the evidence used to guide transfusion practices in this population, with discussion of the impact of transfusion thresholds on blood utilization. The second speaker will discuss the implementation of clinician-driven transfusion guidelines in which the electronic medical record was utilized to drive physician-ordering practices, process improvement and accountability. Synthesizing the current evidence in the literature regarding transfusion thresholds and working with clinicians regarding transfusion practices will improve individual patient care as well as overall health-care delivery, by eliminating unnecessary transfusions and conserving valuable and limited biologic resources.