If renal anemia reaches a severe level, blood transfusion is possible. Renal anemia is a common complication in uremic patients due to decreased erythropoietin, increased erythropoietin growth inhibitory factor, shortened erythrocyte lifespan, deficiencies of folic acid and vitamin B12, and inadequate iron intake. In addition, secondary hyperparathyroidism, chronic inflammation, infections, gastrointestinal bleeding, increased menstruation, inadequate dialysis and blood loss during dialysis are all causes of renal anemia. For the treatment of renal anemia, the main measure is to treat the cause. Blood transfusion can lead to transfusion reactions, especially for patients with kidney transplants, and transfusion increases the risk of allergic sensitization. Blood transfusion may be considered when acute blood loss occurs or when hemoglobin is below 60 g/L with symptoms of hypoxia. Blood transfusion may also be considered in the elderly who are less tolerant of anemia and have a hemoglobin below 80 g/L.