Artificial Intelligence Implementation in Transfusion Medicine: Addressing the Challenges of Clinical Adoption

Artificial intelligence (AI) and machine learning (ML) are increasingly promoted to enhance transfusion and patient blood management, yet real-world implementation remains rare. We reviewed recent exemplar studies reporting prospective deployment with workflow integration to examine translational features, barriers, and enablers of AI/ML integration. On June 18, 2025, we searched PubMed and Web of Science for articles from January 2022 onward. Of 1243 records screened and 31 full texts reviewed, 3 studies met inclusion criteria. The exemplars comprised: (1) a laboratory-embedded tool predicting low ferritin in anemic adults, which during a 21-day deployment identified additional iron deficiency relevant to pretransfusion optimization; (2) a patient-facing smartphone application estimating hemoglobin from fingernail images, adopted nationally by >200,000 users with potential implications for anemia screening; and (3) a clinician-facing smartphone decision support tool predicting resuscitation needs in trauma, piloted across 5 centers with acceptable feasibility and user satisfaction in a transfusion-intensive setting. Common enablers included alignment with clinical need, use of existing data infrastructure, interpretable tree-based models, and early stakeholder engagement. Persistent barriers were data quality and governance, limited generalizability, and absence of economic evaluation. Importantly, no study demonstrated improvement in clinical outcomes or cost. For clinical adoption, AI tools must integrate into routine workflows with clear safety, monitoring, and regulatory plans. Future research should apply implementation frameworks from the outset, evaluate downstream impact on transfusion practice and outcomes, and prioritize scalable approaches such as laboratory-embedded analytics, interoperable decision support, and patient-centered digital tools.