1 Introduction

1.1 Background

For many physicians and clinicians and across many different specialties, blood transfusion is still considered the first line treatment when facing anaemia and/or blood loss. In the European Union (EU), more than 5 million patients are receiving around 24 million units of blood or blood components each year (Annual Summary of the Reporting of Serious Adverse Reactions and Events, 2015, European Commission1). However, a large body of clinical evidence shows that in many clinical scenarios both anaemia and blood loss can be effectively treated with a series of evidence-based measures to better manage and preserve a patient’s own blood, rather than resorting to a donor’s blood, thus leading to a significant overall reduction of blood transfusions.

This is why over the last decade the focus in the EU, and elsewhere, has shifted from ensuring safety and quality of blood and blood components (product focused) towards a broader concept that takes a holistic, multi-disciplinary approach to caring for each patient’s haematopoietic system in a manner that aims to ensure the best possible outcome (patient-focused). This widely accepted approach is referred to as Patient Blood Management (PBM).

According to the WHO, patient blood management (PBM) is a “patient-focused, evidence based and systematic approach for optimising the management of patients and transfusion of blood products to ensure high quality and effective patient care” (1). In 2010 the World Health Assembly Resolution WHA63.12 endorsed PBM specifically referring to the three-pillar concept “bearing in mind that patient blood management means that before surgery every reasonable measure should be taken to optimise the patient’s own blood volume, to minimise the patient’s blood loss and to harness and optimize the patient-specific physiological tolerance of anaemia” (2). The resolution urges WHO Member States to promote PBM where appropriate. It also requests the Director General of the WHO to provide guidance, training and support to Member States on safe and rational use of blood products and to support the introduction of transfusion alternatives and PBM.