This special edition unites evidence, clinical practice, and global implementation experience to position Patient Blood Management as an essential standard of care, and anaesthesiologists as its primary champions.
WFSA is pleased to announce the release of Update in Anaesthesia (UIA) Volume 42. As the official education journal of WFSA, UIA continues to provide clear, clinically relevant learning for anaesthesiologists working across diverse settings worldwide.
In his guest editorial, Dr. Axel Hofmann opens with a striking reminder: although the World Health Organization declared Patient Blood Management (PBM) an urgent global priority in 2021, implementation remains far from universal. Drawing on decades of evidence — including returns on investment exceeding sevenfold — he argues compellingly that structural change, national policy commitment, and multistakeholder engagement are all within reach, and that the time to act is now.
A second guest editorial by Prof. Daniela Filipescu and Dr. Fredy Ariza reinforces this call, framing PBM not merely as a clinical framework but as an ethical obligation for anaesthesiologists worldwide. They reflect on the pivotal role of WFSA’s perioperative PBM (p-PBM) programme in building local champions, advancing multidisciplinary collaboration, and embedding PBM as a cornerstone of perioperative excellence and global health equity.
This volume brings together contributions from anaesthesiologists spanning four continents, coordinated by the UIA editorial team under Editor-in-Chief Prof. Christina Lundgren and Deputy Editor Dr. Bala Bhaskar. Collectively, the articles address the full scope of perioperative PBM: from evidence synthesis to clinical algorithms, from the operating theatre to the delivery room, and from high-resource centres to low- and middle-income settings.
- Optimising Surgical Outcomes: Evidence-based Interventions across the Three Pillars of Patient Blood Management presents a contemporary synthesis of the evidence supporting PBM across diverse surgical populations. The article maps interventions from preoperative anaemia screening and iron therapy, through intraoperative blood conservation and haemostasis management, to postoperative restrictive transfusion practice, demonstrating that integrated application of PBM’s three pillars consistently reduces transfusion rates, complications, length of stay, and costs.
- The Role of Antifibrinolytics and Haemostatic Agents in Pillar II: Are We Making the Most of the Evidence? critically evaluates the current evidence base for tranexamic acid, fibrinogen concentrate, and prothrombin complex concentrates in major surgery and trauma. The article argues that while powerful pharmacological tools exist to manage the “lethal triad” of coagulopathy, acidosis, and hypothermia, the field must move beyond empiric protocols toward goal-directed, viscoelastic assay-guided haemostatic resuscitation to truly realise their potential.
- Perioperative Anaemia: When to Act, How to Treat, and Who Should Be Involved? provides a practical, evidence-based, and resource-adaptable framework for managing perioperative anaemia, addressing when to screen, how to diagnose underlying causes — from iron deficiency to chronic inflammation and chronic kidney disease — and how to initiate timely treatment using oral or intravenous iron across all healthcare settings, including resource-limited environments.
- Navigating Complex Coagulopathies: A PBM Approach to Trauma and Major Surgery explores how PBM principles can guide haemostatic management in trauma, cardiac surgery, and major haemorrhage. The article advocates for early physiological stabilisation, point-of-care viscoelastic diagnostics, and targeted correction of specific haemostatic deficits, replacing empiric ratio-based transfusion with a personalised, outcome-driven approach that conserves scarce blood resources and reduces secondary harm.
- Paediatric Patient Blood Management: A Forgotten Population? examines how the three pillars of PBM can be adapted to neonates, infants, children, and adolescents, whose unique physiology, blood volumes, and coagulation development demand paediatric-specific definitions, algorithms, and decision-support tools. The article calls for greater prioritisation of paediatric PBM research and clinical pathways to close the gap between adult and childhood practice.
- Patient Blood Management in Obstetric Anaesthesia: New Frontiers for Safer Deliveries applies PBM across the full obstetric continuum: from antenatal anaemia screening and iron therapy, through evidence-based intrapartum blood conservation, to the structured management of postpartum haemorrhage. The article demonstrates how early identification, risk stratification, and protocol-driven intervention can reduce transfusion exposure and improve maternal and foetal outcomes globally.
- Reducing Unnecessary Transfusions in Surgery: A Frontline Anaesthesiologist’s Perspective on Patient Blood Management draws on real-world experience from diverse healthcare systems, including low- and middle-income countries, to show that effective PBM does not depend on advanced technology alone, but on culture change, education, teamwork, and consistent bedside decision-making. The article empowers frontline clinicians to move from reactive transfusion to proactive, patient-centered care.
- Scaling Up Patient Blood Management: Lessons from Global and Regional Implementation Efforts synthesises international PBM implementation experience to identify the key drivers of sustainable adoption, including governance, clinical leadership, multidisciplinary education, data systems, and contextual adaptation. The article offers a practical roadmap, grounded in the Donabedian framework, for embedding PBM within routine clinical practice, institutional policy, and national health strategies, aligned with WHO guidance.
Update in Anaesthesia Volume 42 is now available to read online. We extend our sincere thanks to all contributors and editorial partners for their dedication and expertise in creating this issue.
