INTRODUCTION This study was conducted to determine factors that predict the need for blood transfusion in patients undergoing transsphenoidal surgeries for pituitary lesions in the Lagos University Teaching Hospital (LUTH), Idi Araba. MATERIALS AND METHODS This was a prospective study carried out on all patients undergoing transsphenoidal pituitary surgeries over a one-year period. Patients were assessed pre- operatively for anthropometric, clinical, laboratory and neuro- imaging parameters. The number of units of blood requested pre- operatively, number of units of blood provided by the blood bank on call of patient to theatre, and the need for blood transfusion intraoperatively or in the perioperative period were documented. Intraoperative details were documented, and these included the lead surgeon’s identity, duration of surgery, tumor characteristics at surgery and estimated blood loss. Patients were followed into the post-operative period and blood transfusion needs in the post-operative period as well as post-operative outcome were documented. The primary outcome parameter was the need for blood transfusion. The volume of blood loss at surgery and the need for blood transfusion were each correlated to anthropometric, laboratory, radiologic and intraoperative findings as well as surgeon related factors. RESULTS A total of 43 patients were recruited into this study with a male to female ratio of 1.53:1. Over 50% (n= 23) of the patients were in the fifth to sixth decade of life with an overall median age of 49 years for patients recruited. Our crossmatch transfusion ratio was 17.4, implying insignificant use of blood for transsphenoidal pituitary surgeries. There was no correlation of patients’ ages, body mass indices, pituitary adenoma sizes or grades, or preoperative blood parameters with the volume of blood loss at surgery, and neither did they correlate to the need for blood transfusion (P > 0.05). Surgeon related factors as it pertains to duration of surgery however correlated significantly to the volume of blood loss (P= 0.004) and the need for blood transfusion at surgery (P< 0.001). A firm tumor consistency at surgery as opposed to a friable one was also associated with the need for transfusion at surgery (P= 0.006).