WHO’s new PBM guidance offers a practical phased approach to tackling anaemia and improving patient outcomes, especially in resource-limited settings.
In March 2025, the World Health Organization (WHO) released its long-awaited “Guidance on Implementing Patient Blood Management (PBM) to Improve Global Blood Health Status”.[1] This landmark document is poised to reshape the global landscape of perioperative and public health care by offering an actionable roadmap for implementing PBM as a national standard of care. This publication represents a milestone in the global health agenda, particularly for low- and middle-income countries (LMICs) facing disproportionate burdens of anaemia, blood loss, and transfusion dependency.[2], [3]
A Practical Guide Built on Global Expertise
The development of the guidance involved a multidisciplinary panel of global experts, including public health experts, clinicians, researchers, implementation scientists, quality managers, and patient advocates who contributed their insights under the coordination of WHO’s External Steering Committee for the Implementation of Patient Blood Management. The methodology behind this work was grounded in real-world data, peer-reviewed clinical and health-economic evidence, and extensive stakeholder engagement, ensuring its relevance across diverse health systems, especially those with limited resources.
Importantly, the guidance adopts the “8-model”, a structured, three-phase pathway that supports health authorities through the full spectrum of PBM implementation:
- Phase A: Preparing the national/ jurisdictional healthcare system for PBM
National ministries of health establish PBM as a public policy priority, anchor it within existing quality and safety frameworks, and initiate essential education and public empowerment strategies. - Phase B: Conducting PBM pilot project(s)
Health care organizations (HCOs) initiate PBM pilots led by local champions. These pilots focus on process re-design, cultural change, and measurable outcomes such as reduced transfusion rates, improved haemoglobin levels, and shorter hospital stays. - Phase C: Rolling out PBM on a national/jurisdictional scale
Successful pilot sites are designated as reference centres, with structured roll-out plans including mandatory data collection, professional certification, and national benchmarking.
Relevance and Opportunity for LMICs
The burden of impaired blood health is staggering over 3 billion individuals worldwide are affected by iron deficiency, anaemia, and bleeding disorders. These conditions are especially prevalent in LMICs, where structural limitations and access barriers further compromise patient outcomes.[4]
The new WHO guidance does not take a one-size-fits-all approach. Instead, it introduces tailored PBM Toolkits (practical resources adapted to the specific needs of low-income, lower-middle, upper-middle-income and high-income countries). These toolkits empower local teams with step-by-step strategies for addressing the most critical vulnerabilities, such as postpartum haemorrhage, trauma-induced coagulopathy, and childhood anaemia.
Even where resources are scarce, the guidance illustrates how focused PBM interventions (e.g., anaemia screening in pregnancy, rational use of tranexamic acid, and institutional PBM protocols) can yield significant improvements. For example, improving preoperative iron management or implementing simple bleeding management algorithms may reduce maternal deaths and transfusion demand, easing strain on already overburdened health systems.
Why This Matters Now
This guidance emerges at a time when global health systems are under immense financial and operational stress. By aligning PBM with the main deliverables of public health, i.e. health promotion, health protection, and disease prevention (the 3Ps), and grounding its clinical implementation in evidence, economics, and ethics (the 3Es), the WHO offers a sustainable, scalable solution to one of the world’s most underestimated public health issues.[5]
For LMICs, the benefits extend beyond clinical metrics. The overarching aim of implementing PBM is blood health. Ultimately, this contributes to health equity, patient empowerment, and long-term resilience of national health systems. The reallocation of resources, away from unnecessary transfusions and toward essential diagnostics, treatments, and education fosters a virtuous cycle of improved care and system-wide efficiency.
A Call to Action
The WHO’s Policy Brief on PBM stated in 2021: “PBM has the potential to significantly improve global population health and the clinical outcomes of hundreds of millions of surgical, medical and obstetric patients and the population at large, while reducing health care costs by billions of US dollars”, and consequently, “All Member States should act quickly… to adopt their national PBM policy, install the necessary governance, and reallocate resources to improve the population health status and individual patient outcomes.”[6]
With the WHO’s Guidance on Implementing PBM we are looking at the next iteration: being more than a technical manual, it offers ministries of health, clinical leaders, and public health stakeholders around the world the vision, structure, and tools to move from fragmented practices toward a unified model of blood care grounded in safety, sustainability, and patient-centeredness.
WFSA fully embraces WHO’s urgent call to implement PBM worldwide. This is our moment to ensure that better blood health is not a privilege of a few, but a right of all.
(Written by F. Ariza, A. Hofmann, and D. Filipescu)
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Perioperative- Patient Blood Management (P-PBM)
REFERENCES
[1] World Health Organization. (2024). Guidance on implementing patient blood management to improve global blood health status. World Health Organization. https://iris.who.int/handle/10665/380784. License: CC BY-NC-SA 3.0 IGO.
[2] Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019 Aug;1450(1):15-31.
[3] Hmida MA, Mahjoub S, Ben Hamed L, Mojaat N, Bahloul A, Hmida S. Transfusion safety: Is there a difference between reported reactions in low-to-middle income and high-income countries? Transfus Apher Sci. 2024 Jun;63(3):103916.
[4] Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, Regan M, Weatherall D, Chou DP, Eisele TP, Flaxman SR, Pullan RL, Brooker SJ, Murray CJ. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014 Jan 30;123(5):615-24.
[5] Leahy MF, Hofmann A, Towler S, Trentino KM, Burrows SA, Swain SG, Hamdorf J, Gallagher T, Koay A, Geelhoed GC, Farmer SL. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion. 2017 Jun;57(6):1347-1358.
[6] The urgent need to implement patient blood management (WHO Policy Brief). Available in: https://www.who.int/publications/i/item/9789240035744
