Blood component transfusions are a valuable clinical intervention and are widely used in healthcare. However, some patients may decline transfusion, for example if it conflicts with their religious beliefs or they are concerned about the associated risks. This article details a narrative review that was undertaken to identify what alternative patient management strategies can be used when allogeneic blood transfusion is not feasible, and to explore how these strategies can benefit individuals who decline transfusion and the broader patient population. Searches were conducted to identify articles published between 2013 and 2023. A total of 43 articles were included in the review and thematically analysed. Four main alternative approaches to transfusion were identified from the literature: blood management and conservation; early optimisation; use of synthetic compounds; and proactive management in emergencies. Applying these strategies could reduce risks and costs, enhance the overall use of blood components, and ensure a holistic approach to care and maintaining haemostasis for all patients.