Background:The proper use of blood products can be life-saving, but it requires careful management and adherence to established guidelines to ensure that transfusions are safe, effective, and appropriately utilized. Blood banks and transfusion services are integral to this process, managing the collection, testing, storage, and distribution of blood and blood products. The aim of this study was to analyse transfusion practices at a tertiary care hospital’s blood bank, assessing clinical indications for blood transfusions, types of blood products used, adherence to transfusion protocols, and associated transfusion reactions. Materials and Methods: This retrospective observational study included 400 patients who received blood transfusions. Data were collected from hospital blood bank records, documenting patient demographics, clinical indications for transfusion, types of blood products used, transfusion reactions, and pre-transfusion testing. The appropriateness of transfusions was assessed based on established guidelines. Statistical analysis was performed using SPSS version 20. Results: The study population was equally distributed by gender, with the majority of patients aged 31 to 50 years. Trauma (30%) and anemia (25%) were the leading indications for transfusion. Red blood cells were the most commonly used product (62.5%), followed by fresh frozen plasma (17.5%) and platelets (12.5%). Most patients (92.5%) did not experience adverse reactions, with fever being the most common (5%). The majority of transfusions (97%) were deemed appropriate according to clinical guidelines, while 3% were considered inappropriate. Conclusion: The study reveals that transfusion practices are largely appropriate, with strong adherence to transfusion guidelines and minimal adverse reactions. However, a small percentage of transfusions were deemed inappropriate, suggesting a need for continued education and guideline reinforcement to optimize blood utilization and improve patient outcomes.