A systematic, patient-centered and evidence-based approach to preserving Blood Health and improving clinical outcomes.
Patient Blood Management reorganizes care to identify and treat anemia, reduce blood loss, optimize hemostasis and individualize transfusion decisions. More than an isolated protocol, it is a model of care that places the patient at the center of blood-related decisions.
PBM represents a structural transformation in blood-related care. Rather than treating transfusion as an automatic response to anemia or blood loss, the model anticipates problems, organizes processes and individualizes clinical management.
At its core, PBM seeks to improve clinical outcomes through the management and preservation of the patient’s own blood using a systematic, patient-centered and evidence-based approach.
This means recognizing anemia and bleeding as clinical problems to be investigated and treated, valuing Blood Health and reserving transfusion for situations in which its benefits clearly outweigh the risks.
The pillars are interdependent and should be applied throughout the patient journey in an integrated and individualized manner.
Identify and treat anemia and hematinic deficiencies before transfusion becomes an automatic response. Etiological investigation, management of iron deficiency and correction of other treatable causes play a central role.
Reduce bleeding and preserve hemostasis throughout all phases of care. This includes planning, surgical and anesthetic techniques, antifibrinolytics, guided hemostasis and intraoperative cell salvage in appropriate settings.
Recognize the physiological capacity to adapt to anemia and individualize the transfusion decision. Symptoms, clinical context, comorbidities and signs of hypoxia matter more than an isolated hemoglobin value.
Patient Blood Management is not an anti-transfusion approach. Blood transfusion can be useful and potentially lifesaving when appropriately indicated.
PBM proposes changing the logic of decision-making: investigate and treat modifiable causes, reduce avoidable losses and assess transfusion needs carefully, contextually and based on evidence.
The goal is not to reach “zero transfusion,” but to ensure that each patient receives the most appropriate treatment for their clinical condition with the lowest possible risk.
“Beyond reducing transfusions, PBM reorganizes care to preserve the patient’s Blood Health and improve clinical decision-making.”
Educational summary · Blood ManagerThe literature reviewed in PBM Essencial shows that structured PBM programs may provide benefits beyond reducing the use of blood components.
Multimodal programs and core PBM strategies have been associated, in the settings studied, with lower transfusion exposure, fewer complications and improved clinical outcomes.
More rational use of blood components, fewer complications and organized care may reduce direct and indirect costs and contribute to healthcare sustainability.
PBM reinforces autonomy, shared decision-making, beneficence, non-maleficence and distributive justice in the use of a valuable and limited biological resource.
Among 235,779 surgical patients, a multimodal PBM program was associated with a 20% reduction in total complications and an 11% reduction in mortality. These findings apply to the body of studies evaluated and do not guarantee individual benefit.
In Western Australia, a large-scale PBM program was associated with risk-adjusted reductions in hospital mortality, hospital-acquired infections and cardiovascular events, as well as savings related to blood component use.
Blood Health broadens the focus to the patient’s hematological condition throughout the care journey. Blood is no longer viewed only as a transfusion product, but as an essential component of physiology, safety and clinical outcomes.
In this context, the Three Pillars explain how PBM works. The Three Ps express what care aims to achieve: promote the best possible hematological condition, protect life from unnecessary blood loss and exposure, and prevent avoidable causes of anemia and bleeding.
Effective implementation requires collaboration among different professionals and areas of care. Surgeons, anesthesiologists, physicians, intensivists, hematologists, nurses, pharmacists, perfusionists, managers and other professionals contribute complementary expertise.
Patients and their families also play a central role, especially in education, understanding therapeutic alternatives and shared decision-making.
PBM success depends on integrating clinical expertise, institutional leadership, continuing education and a culture focused on safety and quality of care.
Multidisciplinary approachInstitutional implementation goes beyond adopting a protocol. It depends on cultural change, leadership, education, defined processes and monitoring of outcomes.
Map anemia, transfusions, bleeding, care practices, barriers and opportunities for improvement.
Engage leadership and key professionals to build a multidisciplinary institutional strategy.
Organize pathways for anemia, hemostasis, blood-loss minimization and individualized transfusion decision-making.
Monitor indicators, communicate results, provide ongoing education and incorporate improvements into the system.
Hematologist and transfusion medicine physician working in transfusion medicine, healthcare management, patient safety, education and Patient Blood Management implementation.
This content was developed from the concepts presented in PBM Essencial: Transformando o Cuidado, Salvando Vidas, a technical-scientific and multidisciplinary work dedicated to the foundations, pillars, evidence and implementation of PBM.
PBM stands for Patient Blood Management. It is a systematic, patient-centered and evidence-based approach to preserving Blood Health and improving clinical outcomes.
No. Although the perioperative setting is one of the most developed, PBM principles can be applied across different areas of medicine, from clinical care to intensive care, always according to the context and available evidence.
No. Transfusion remains a potentially lifesaving intervention when appropriately indicated. PBM seeks to avoid automatic decisions and promote individualized assessment of risks, benefits and alternatives.
The first step is to understand the institutional setting, build a multidisciplinary coalition and define measurable priorities. Education, leadership and indicator monitoring are essential for sustainability.
Last editorial update: August 2026.
Discover the book that brings together historical foundations, physiological principles, the Three Pillars, transfusion decision-making, transfusion medicine management, institutional implementation and future perspectives in Patient Blood Management.
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