Background: For elective surgeries preoperative over ordering of blood is very commonrnpractice and leads to holding up of the blood bank reserve, ageing of the blood unit and wastagernof blood bank resources. That can be decreased by simple means of changing the blood crossrnmatching and ordering schedule depending upon the type of surgery performed.rnObjectives: To assess blood requisition, transfusion practices and factors associated withrntransfusion in elective surgical proceduresat TikurAnbessa specialized HospitalfromFebruary 1rnto March 31, 2016 G.C.rnMethods:An Institution based cross sectional study was conducted from February 1, 2016 tornMarch 31, 2016 G.C at Tikur Anbessa specialized Hospital. Using sequential sampling techniquernand structured checklist data was collected from all elective surgical patients that came duringrnthe 2 months period. Blood utilization was calculated using cross match to transfusion ratiorn(C/T), transfusion probability (%T), transfusion index (TI) and Maximum surgical blood-rnordering schedule (MSBOS) is formulated by Mead's criterion for common surgical procedures.rnMultivariate logistic regression analysis was conducted to identify significant predictors ofrntransfusion based on p-value less than 0.05 with 95% confidence level.rnResults: Among all 242 elective surgical patients 55 (22.7%) of patients were transfused withrn107(20.4%) units of the prepared blood giving cross-match to transfusion ratio of 4.9,transfusionrnprobability (%T) 22.7% and transfusion index of 0.44. The independent predictors ofrnperioperative blood transfusion were being neurosurgery (craniotomy) [AOR= 5.868 (95%CIrn1.364, 25.239)] (P=0.017), Hgb 15 %( [AOR=12.830, (95% CI, 5.613, 29.323)] (P = .000).rnConclusion and Recommendation: The amount of blood requested and cross-matched forrnpatients undergoing elective surgery is much greater than the amount actually used. So bloodrnordering pattern needs to be revised and over ordering of blood should be minimized. This canrnbe possible by implementing an updated, institution-specific MSBOS along with an EmergencyrnBlood Releasing system.