BACKGROUND:: Although blood transfusion is a common therapeutic intervention and a mainstay of treating surgical blood loss, it may be perceived by patients and their physicians as having associated risk of adverse events. Practicing patient-centered care necessitates that clinicians have an understanding of an individual patient's perceptions of transfusion practice and incorporate this into shared medical decision-making. METHODS:: A paper survey was completed by patients during routine outpatient preoperative evaluation. An online survey was completed by attending anesthesiologists and surgeons at the same institution. Both surveys evaluated perceptions of the overall risk of transfusions, level of concern regarding 5 specific adverse events with transfusion, and perceptions of the frequency of those adverse events. Group differences were evaluated with conventional inferential biostatistics. RESULTS:: A total of 294 patients and 73 physicians completed the surveys. Among the surveyed patients, 20% (95% confidence interval, 15%-25%) perceived blood transfusions as "very often risky" or "always risky." Greater perceived overall blood transfusion risk was associated with African American race (P = 0.028) and having a high school or less level of education (P = 0.022). Greater perceived risk of allergic reaction (P = 0.001), fever (P < 0.001), and dyspnea (P = 0.001) were associated with African American race. Greater perceived risk of allergic reaction (P = 0.009), fever (P = 0.039), dyspnea (P = 0.004), human immunodeficiency virus/acquired immune deficiency syndrome and hepatitis (P = 0.003), and medical error (P = 0.039) were associated with having a high school or less level of education. Patients and physicians also differed significantly in their survey responses, with physicians reporting greater overall perceived risk with a blood transfusion (P = 0.001). CONCLUSIONS:: Despite improvements in blood transfusion safety in the United States and other developed countries, the results of this study indicate that a sizeable percentage of patients still perceive transfusion as having significant associated risk. Furthermore, patients and their anesthesiologists/surgeons differ in their perceptions about transfusion-related risks and complications. Understanding patients' perceptions of blood transfusion and identifying groups with the greater specific concerns will better enable health care professionals to address risk during the informed consent process and recommend blood management in accordance with the individual patient's values, beliefs, and fears or concerns. Copyright © 2014 International Anesthesia Research Society.