The purpose of this study was to assess appropriateness of red blood cell (RBC) transfusion in the emergency department before and after a specific protocol. A retrospective monocenter study was realized during two six-month periods at the emergency unit. A protocol based on the French national guidelines (HAS) in 2014 was set up between the two periods. All the adult patients, except in a context of massive transfusion, were included in the study. The principal criteria analysed was the rate of appropriate transfusion. Ninety-five patients were included during the first period (group 1) and 98 during the second one (group 2). The rate of appropriateness was the same in the two groups (81% for the group 1 and 81.6% for the group 2). The inappropriate indications were more frequent with older patients (74.6 ± 15.2 years in the group 1 and 79.5 ± 8.5 in the group 2, P=0.01) and patients suffering from a stable coronary artery disease (18.5% in the group 1 and 38.9% in the group 2, P=0.008). The rate of appropriate red blood cells transfusion, already high at the beginning of the study, could not be significantly improved with the institution of a specific protocol. It is necessary to continue medical training. Copyright © 2018 Elsevier Masson SAS. All rights reserved.