An Indian anaesthesiologists’ perspective on how the second pilot of the WFSA Perioperative-Patient Blood Management (P-PBM) Facilitator Course transformed their understanding of PBM, from optimising the use of blood components to leading sustainable, patient-centred change.
By Dr Rijuta Pradhan Kashyapi and Dr Kalyani Nilesh Patil
From Optimal Blood Use To PBM
As practising anaesthesiologists, we have long recognised that blood components are precious and often scarce resources. Consequently, the principles of optimal blood use have always been integral to our clinical practice.
Our perspective began to broaden during the ABC-TAMS Course-WS led by Dr Fredy Ariza, WFSA P-PBM Co-chair and lead expert, at GARC 2022 in Coimbatore, India. At that time, the workshop strengthened our ability not only to apply strategies for managing major bleeding, but also to teach them. More recently, we began learning about the WFSA P-PBM project and recognised that, although it shared many principles with ABC-TAMS, it offered an even broader perspective. It helped us understand that protecting and managing the patient’s own blood is one of the most effective strategies for reducing the unacceptably high reliance on blood components to manage anaemia, bleeding and coagulopathy.
PBM is a patient-centred, systematic and evidence-based approach that seeks to protect and optimise the patient’s own blood health throughout the care pathway.[1] This shift from focusing primarily on blood products to focusing on the patient, encouraged us to consider establishing comprehensive P-PBM programmes in our own institutions. Such strategies are particularly relevant in a country like India, where anaemia is highly prevalent and the scarcity of blood components remains a major limitation.
The ambition was clear, but the pathway was challenging. The barriers were not limited to gaps in knowledge. Implementing PBM requires clinicians to reconsider established practices, institutions to redesign clinical pathways and different professional groups to work towards shared objectives. Recent implementation literature similarly highlights the importance of leadership, governance, multidisciplinary collaboration, data systems and continuous education.[2]
We soon realised that the first step towards sustainable change is education.
An Opportunity to Become Agents of Change
A few months before the course, Dr J Balavenkatasubramanian, Dr Fredy Ariza and Dr Vaibhavi Upadhye suggested that attending the second WFSA P-PBM Facilitator Course pilot in Bucharest would support the advancement of PBM education and implementation in India.
We saw this as an invaluable opportunity to learn from a distinguished international faculty and to prepare ourselves to become P-PBM facilitators. The course was coordinated by Professor Daniela Filipescu, WFSA Past President and P-PBM Project Co-chair, and Dr F. Ariza, together with an experienced Romanian faculty team.
We therefore travelled to Bucharest to participate in the two-day pilot course, held on 30–31 January 2026.
Learning By Participating and Enjoying
From the outset, it was evident that this was not a conventional lecture-based programme. The course was highly interactive and consistently encouraged participants to question, discuss, practise and teach. The opening sessions introduced the vision and structure of the WFSA P-PBM Course whose foundations are aligned with the 2021 WHO policy brief.
The programme then explored the three fundamental pillars of perioperative PBM through concise lectures, clinical cases, small-group discussions, games and quizzes. This varied educational approach kept participant actively engaged while continually connecting scientific knowledge with practical decision-making.
The recent ALICE international cohort study found preoperative anaemia in almost one-third of patients undergoing major surgery and demonstrated that, although iron deficiency was the leading cause, vitamin B12 and folate deficiencies also contributed substantially.[3] Findings such as these, reinforce why PBM education must teach clinicians to investigate anaemia systematically rather than treating haemoglobin as an isolated laboratory value.
When The Participants Became The Faculty
One of the most memorable components was the session on P-PBM in special populations. Instead of simply delivering the subject to us, the faculty invited participants to prepare and conduct the session themselves.
This reversal of roles was both challenging and rewarding. It required us to organise information, communicate key messages clearly, respond to questions and facilitate learning among our peers. In doing so, we moved from being recipients of knowledge to becoming educators.
For a facilitator course, this distinction is essential. Knowing the principles of P-PBM is not enough. Facilitators must be able to engage different audiences, adapt the content to local circumstances and create an environment in which participants learn actively from one another.
Looking Beyond Individual Clinical Decisions
The final sessions and discussions expanded our perspective from bedside practice to institution-wide and health-system implementation. This approach reflects the 2024 WHO guidance on implementing PBM, which positions PBM as a comprehensive health-system strategy requiring effective governance, stakeholder engagement, education, clinical pathways, reliable information systems, benchmarking the outcomes, and public awareness.
This broader perspective was particularly relevant to us because establishing PBM cannot depend exclusively on the enthusiasm of a few clinicians. Sustainable implementation requires institutional ownership and coordinated action.
The group discussions allowed us to explore common implementation barriers and identify realistic opportunities for change. The brainstorming sessions were complemented by immersive simulation scenarios at the end of the course. The experiential activities brought together clinical knowledge, teamwork, communication, leadership and decision-making under pressure. Collectively, they transformed abstract implementation concepts into practical skills that we could take back to our institutions.
From Bucharest to Coimbatore, And Beyond
The WFSA P-PBM Bucharest pilot course strengthened our confidence and equipped us with the educational and implementation tools needed to support the development of P-PBM programmes in our hospitals.
Its influence will extend beyond our individual practice. The knowledge and facilitation skills acquired in Bucharest will support us and our colleagues as we contribute to the delivery of the WFSA P-PBM Facilitator Course during GARC in Coimbatore, India, in July 2026.
For us, Bucharest was therefore not simply the destination of a training journey. It marked the beginning of a new responsibility: to translate knowledge into leadership, education into implementation and individual enthusiasm into sustainable institutional change.
We returned to India convinced that P-PBM is not merely about reducing transfusions. It is about respecting and protecting the patient’s own blood, improving outcomes and building safer and more resilient healthcare systems. The most valuable outcome of the course was not only what we learned, but what we now feel prepared to teach and to be instrumental in bringing about a change that will transform patient care.
Acknowledgements
We are deeply grateful to the World Federation of Societies of Anaesthesiologists (WFSA), the Romanian Society of Anaesthesia and Intensive Care (SRATI), Sara Portugal, Amal Paonaskar and Anamaria Petre for their invaluable support in enabling our participation and making our stay in Bucharest so comfortable.
References
1. Shander A, Hardy JF, Ozawa S, Farmer SL, Hofmann A, Frank SM, et al. A global definition of patient blood management. Anesth Analg. 2022;135(3):476–88. doi:10.1213/ANE.0000000000005873.
2. Céspedes IC, Figueiredo MS, Hossne Junior NA, et al. Patient blood management program implementation: comprehensive recommendations and practical strategies. Braz J Cardiovasc Surg. 2024;39(5):e20240205. doi:10.21470/1678-9741-2024-0205.
3. Choorapoikayil S, Baron DM, Spahn DR, Lasocki S, Boryshchuk D, Yeghiazaryan L, et al. The aetiology and prevalence of preoperative anaemia in patients undergoing major surgery (ALICE): an international, prospective, observational cohort study. Lancet Glob Health. 2025;13(12):e2041–50. doi:10.1016/S2214-109X(25)00320-1.
