Dear patient. Greetings from health care magic!!! I am Dr Thakker and shall be answering your question. I can understand your reservations about blood transfusion and when it should be done. I will try my best to answer your question and guide you through the problem. Your sister has a HB of 3.5gm/dl. The normal HB for her is 12gm/dl. Her anemia can be multifactorial, blood loss due to fibroids, nutritional, menstrual loss. HB of 3.5gm/dl is a very low haemoglobin. The body goes into a state of high output cardiac failure and blood is not able to deliver enough oxygen to the tissues. Oxygen is a basic requirement of the cells. Hypoxia leads to accumulation of acids in the blood and the patient feels tired and breathless. Hence I would recommend your sister be transfused with a total of 3 to 4 packed cells to get the HB till 7gm/dl. She can then be treated for the cause. she can then be given hematinics, intravenous iron and treated for fibroids if any. Current day transfusions are safe and the risk of acquiring diseases is minimal. Hence you shouldn t worry about that,. I hope this helps you out. If you have any more questions, please do not hesitate to write back to me. Yours sincerely, Dr Thakker.