Background: Availability of blood for transfusion, its need, quality and safety of blood transfusion depends on the geographical location as well as state of medical care in that area. Misuse or overuse of this naturally available resource has to be avoided. Aim: To review blood component usage and to assess the pattern of blood usage in a tertiary care hospital. Materials and methods: This study was conducted at a blood bank of a tertiary health care hospital. Details of the blood and component recipients in one representative month were recorded. Results: Supply of blood was found to be more in the surgical wards forming 57.36% (n=343/598) of total supply. The most common diagnosis for patients requiring blood transfusion was anemia (n=157, 26.25%). Anemia (353/620, 56.93 %) was also the most common indication for packed red blood cells (PRBCs) transfusion followed by surgery (194/620, 12.24%). Thrombocytopenia was the commonest indication for platelet transfusion (378/514, 23.85%). Highest number of fresh frozen plasma (FFP) units was utilized for patients with hypoproteinemia (79/166, 45.78%). Our audit shows that the use of PRBCs has largely replaced that of whole blood. Conclusion: Appropriate guidelines need to be set to reduce the inappropriate transfusions of blood components like PRBCs, platelets, and FFP. The clinician should always bear in mind that transfusion can lead to serious complications and benefit/risk assessment must be taken into account before each transfusion.