Objectives: To analyse and report the utilisation of Red Blood Cell (RBC) transfusion in a tertiary Otolaryngology, Head and Neck Centre. Design: Retrospective cohort review. Setting: Large tertiary care centre in England. Participants: All in-patients (n = 89) admitted primarily under the care of Otolaryngology, Head and Neck service between January 2015 and December 2019 that required RBC transfusion. Main Outcome Measures: Number of units of Red Blood Cell transfused over 5 years and distribution across clinical indications. Cost of RBC transfusions over the same time period. Results: Most patients receiving transfusions are aged in their 6th and 7th decades. Epistaxis patients utilised 105 RBC units over the 5 years with 78 % being for emergency epistaxis. Post-operative Head & Neck Cancer surgery with reconstruction required 32 RBC units over 5 years in 12 patients. The cost incurred by the department has fallen by over £2000 over the 5 year period. Conclusions: Blood transfusion use has fallen over the last five years. Epistaxis and post-operative Head and Neck cancer cases account for significant use compared with other patient groups. Prehabilitation strategies will add value towards mitigating future consumption of RBC.