The regulations for pretransfusion testing are based in part on concerns for patient safety. To preserve the precious universal donor blood supply and to maintain patient safety, full pretransfusion testing (i.e., a type and screen (T&S) and a crossmatch) should be performed before the blood bank releases blood products to the operating room. Emergency release of universal donor blood for an elective, high blood loss surgical procedure because pretransfusion testing was not performed is inappropriate blood utilization. The Maximum Surgical Blood Order Schedule (MSBOS) is an institution specific, data-driven prediction tool to guide pretransfusion testing and transfusion requirements. Patient verification is a critical step in the pretransfusion process to prevent a potentially fatal hemolytic transfusion reaction. Alloimmunization in infants is a rare occurrence but pretransfusion testing is still required in specific infant patient populations.