Last month, Gavin J. Murphy published outcomes of a multicentre randomised trial comparing restrictive red blood cell transfusion (< 7.5 g/dl = 4.7 mmol/l) vs a liberal transfusion regimen (< 9g/dl = 5.6 mmol/l) in 2003 patients undergoing elective cardiac surgical procedures (1). This study was carried out in 17 cardiac surgery centres in the UK. The primary outcome was a serious infection (sepsis or wound infection) or an ischaemic event (permanent stroke, myocardial infarction, infarction of the gut, or acute kidney injury) within three months after randomisation. Transfusion rates after randomisation were 53.4% and 92.2% in the two groups, respectively. The primary outcome occurred in 35.1% of the patients in the restrictive-threshold group and 33.0% of the patients in the liberal-threshold group (p = 0.30); there was no indication of heterogeneity according to subgroup. As a secondary outcome, there were more deaths in the restrictive-threshold group than in the liberal-threshold group after 90 days (4.2% vs 2.6%, p = 0.045), but not after 30 days. Serious postoperative complications, excluding primary outcome events, occurred in 35.7% of the participants in the restrictive-threshold group and 34.2% of the participants in the liberal-threshold group. The investigators concluded that a restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or healthcare costs (1). © 2015, Netherlands Society of Intensive Care. All Rights Reserved.