Objectives: To establish blood product usage and wastage within a UK emergency department (ED). Methods: A retrospective case note review of patients presenting to the ED requiring blood products. Results: Between 1 January 2007 and 31 December 2007, 770 transfusion requests were identified, representing 3209 units of blood products. Gastrointestinal bleeding was the most frequent indication for blood product request. 39.5% (1204 units) of blood products ordered were transfused, 47.8% (1458 units) recycled (including 53.4%; 1260 units; of red cell concentrate; RCC), 3.2% (97 units) wasted and 9.5% (289 units) unaccounted for. Median age of recipients was 65 (IQR 46-78) years and 56% of all transfusions were given to patients over 60 years old. Conclusion: Patients receiving blood products are elderly. Up to half of all requested products are recycled having not being used for the indication for which they were requested, and 3% of blood products are wasted. With an ageing population and limited blood product availability, transfusion requests should be more carefully considered.