OBJECTIVES: As part of a medico-economic study on a fibrin sealant used in orthopedic surgery to decrease allogeneic transfusion requirement, this study was conducted to evaluate the overall cost of transfusion from hospital perspective. METHODS: A multicenter prospective study was carried out from March 14, 2011 to June 1, 2011 in orthopedic surgery wards of 3 French university hospitals. A micro-costing has been developed to identify global costs of transfusion through: the acquisition cost of red blood cell (RBC), supplies used for a transfusion, and times spent by medical and nurse staff for the management of the transfusion timed by a pharmacy resident with a stopwatch. Corresponding costs for staff were estimated from mean salaries for medical and non medical staff in 2011. RESULTS: Five transfusions were observed in each site. A physician spent 1’01”± 43” (mean ± standard deviation) for the prescription of RBC. Personal care assistants and hospital workers brought samples to the Blood Bank (BB), transmitted the document to the BB, and delivered RBC to the ward which took 10’17”± 05’46” and 10’47”± 03’20” respectively. Nurses spent 52’23”± 04’39” for the control of the documents, the ultimate pre-transfusion control at patient’s bedside, the administration of RBC and the monitoring of the transfusion. No adverse event occurred during the study. The mean global cost of the transfusion of a RBC was estimated at 254 Euros. Regarding global cost, management of transfusion was estimated at 31 Euros representing 12% of the overall cost of transfusion. CONCLUSIONS: The study shows the heavy workload represented by each transfusion for a nurse in the context of shortage of nurses. These results may be helpful to fill a pharmacoeconomic model used to estimate the incremental cost effective of using fibrin sealant in orthopedic surgery.