Patient Blood Management Resources

Patient Blood Management (PBM) is an evidence-based, multidisciplinary approach aimed at optimising the care of patients who might need transfusion. It puts the patient at the heart of decisions made around blood transfusion, promoting appropriate use of blood and blood components and the timely use of alternatives where available. PBM represents an international initiative in best practice for transfusion medicine.

The Clinical Transfusion Working Party have put together this resource to help support the wider implementation of PBM. It represents experience from a number of countries and contains chapters on various aspects of PBM.

 

PBM Chapters

1. Establishing and implementing a PBM strategy

The principles of PBM build on strategies for good clinical transfusion practice and lessons from haemovigilance. Numerous clinical practice improvement programs for transfusion are already in place internationally. It can be helpful to use established practice improvement frameworks, where these exist, and build on them further to establish a PBM strategy. Updated: January 2026

2. Pre-operative optimisation of haemoglobin

Anaemia is defined by the World Health Organization as a haemoglobin level below 12 g/dL in women and 13 g/dL in men. Specific thresholds apply to pregnant women and children. Anaemia prior to surgery significantly increases the risk of perioperative complications and transfusion. Managing preoperative anaemia is an important part of Patient Blood Management. Updated: January 2026

3. Anti-fibrinolytic agent - Tranexamic acid (TXA)

Concerns regarding the safety of transfused blood have led to the development of a range of interventions to minimise blood loss during major surgery. Anti-fibrinolytic drugs are widely used, particularly in cardiac surgery, and previous reviews have found them to be effective in reducing blood loss, the need for transfusion, and the need for re-operation due to continued or recurrent bleeding. Updated: January 2026

4. Red Cell Restrictive Transfusion Thresholds and Single-Unit Transfusion in Patient Blood Management

Patient Blood Management (PBM) emphasizes on evidence-based, patient-centered strategies to optimize outcomes while conserving blood resources. Central to PBM is the adoption of restrictive transfusion thresholds and the practice of single-unit transfusion, both of which aim to minimize unnecessary exposure to allogeneic blood, reduce complications, and improve clinical outcomes. Updated: January 2026

5. Platelet Transfusion in Adults

Platelet transfusion is a critical medical procedure used to prevent or treat bleeding in patients with low platelet counts, a condition known as thrombocytopenia. This procedure is particularly vital for patients undergoing chemotherapy, those with haematological malignancies, or individuals who have experienced significant blood loss due to trauma or surgery. Updated: January 2026

6. Massive Bleeding Protocols – The Transfusion Service Perspective

Updated: January 2026

7. Artificial Intelligence and Machine Learning in PBM

Patient Blood Management (PBM) has significantly evolved over the past two decades, transitioning from traditional transfusion centred strategies to evidence based, patient-centric approaches that optimize the use of blood and its components. Updated: January 2026

8. Anticoagulant reversal

In this chapter, the reversal of oral, parenteral and subcutaneous anticoagulants will be discussed with a focus on recommendations found in the Antithrombotic Therapy and Prevention of Thrombosis: American College of Chest Physicians Evidence-Based Clinical Practice (ACCP) Guidelines and the American Society of Hematology (ASH) guidelines for management of venous thromboembolism.

9. Transfusion in Hemoglobinopathies

Sickle cell disease (SCD) and ß thalassemia are complex hemoglobinopathies. Although they are grouped together here, their clinical manifestations and treatment modalities differ significantly.

10. Iatrogenic anemia

Published: January 2026

12. Platelet Transfusion in Paediatric and Neonates

Most Platelet transfusions in neonates and paediatric population are small-volume prophylactic transfusions to prevent bleeding in thrombocytopenic patients (i.e., transfusing when platelet counts fall below a defined threshold). Around 65 to 70% of podiatric intensive‑care and oncology patients received platelets prophylactically, and in neonates thresholds counts (e.g. 25 × 10⁹/L for pre‑term infants) are more evident. Published: January 2026

13. Plasma and Clotting Factors in Adults and Pediatrics

Published: January 2026

1. Establishing and implementing a PBM strategy 2. Pre-operative optimisation of haemoglobin 3. Tranexamic acid 4. Red Cell Restrictive Transfusion Thresholds and Single-Unit Transfusion in Patient Blood Management 5. Platelet Transfusion in Adults 6. Massive Bleeding Protocols – The Transfusion Service Perspective 7. Artificial Intelligence and Machine Learning in PBM 8. Anticoagulant reversal 9. Transfusion in Hemoglobinopathies 10. Iatrogenic anemia 12. Platelet Transfusion in Paediatric and Neonates 13. Plasma and Clotting Factors in Adults and Pediatrics