The aim of this study was to determine the indications for transfusion, blood ordering practices and post-transfusion complications, and to assess the clinical transfusion practice at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda. There are no guidelines on the appropriate use of blood at MRRH. Therefore, there was a need to assess the local clinical transfusion practice. Patients' hospital files were studied for evidence of blood transfusions in 2008. All five wards were reviewed and details on the transfusion process were recorded. A total of 1730 patients (median age, 19.0 years; range, 1 day to 88 years; female-to-male ratio, 1.4), for whom blood was cross-matched, were studied. Of these, 1674 (96.8%) patients actually received transfusions, which were as whole blood in 58.4% of recipients. The mean number of units per recipient was 1.7 and the cross-match-to-transfusion ratio was 1.3. The three most frequent indications for transfusion were malaria (38.8%), bleeding (27.1%) and other infections (16.1%). There were no records for pre-transfusion haemoglobin, compatibility testing, transfusion start-times and vital signs in 30.2, 51.8, 21.5 and 97.6% of the recipients, respectively. Transfusion reactions were recorded for 10 (0.6%) patients. Although there was no evidence of blood wastage, inadequacies were noted in the documentation of the transfusion process. There is a need to train staff in blood transfusion and to design a 'blood transfusion form' for easy monitoring and evaluation. A hospital transfusion committee and guidelines on the appropriate use of blood should be put in place at MRRH.