There is no relevant guidelines for perioperative red blood cell (RBC) transfusion for patients at high altitude. There is somehow blindness for anesthesiologist or surgeon to decide whether to transfuse RBC to patients at high altitude. In order to ensure the perioperative safety of patients with polycythemia at high altitude, and to reduce transfusion complications as well as avoid the waste of blood, it is necessary to get a consensus on perioperative RBC transfusion for patients at high altitude. A working group was established led by High Altitude Medicine (Regional Joint) Professional Committee of Sichuan International medical exchange & promotion association at hospital of Chengdu office of People's Government of Tibetan Autonomous Region in 2021. Experts from department of surgery, anesthesiology and blood transfusion have co-authored the "Expert Consensus on Perioperative Red Blood Cell Transfusion of high altitude Population (2021) ", which aims to promote the safety of perioperative blood management for patients at high altitude.