Valerie Neff Newitt
August 2025—The World Health Organization released new guidance this spring to provide aid in implementing patient blood management programs and toolkits to support blood health and patient safety at various resource levels (https://bit.ly/CT_WHO-PBM).
“It’s the job of the clinician to make the right decisions about blood use at the right time. Patient blood management programs help them do that,” says Sherri Ozawa, MSN, RN, a coauthor of the WHO guidance. “What documents like this and others do is help make the bridge between what laboratory professionals already know and changing clinical practice.”
Ozawa is director of patient blood management operations for hc1 of Indianapolis, Ind., a company that optimizes laboratory data to improve clinical practice, enabling better patient care, streamlining operations, and reducing costs.
Estimates put the number of U.S. hospitals or hospital systems with PBM programs or with programs in the works at about 600, says Ozawa, a past president of the Society for the Advancement of Patient Blood Management. “But in terms of uptake, we’re not fully there yet.”
In organized PBM programs, she says, “we are carefully watching who is doing transfusions, who is receiving them, who’s making the decisions, how they’re making the decisions, and when they’re making them. And we have learned that when we shine a light on all of that, and at the same time support better viscoelastic testing, better anemia management, better blood conservation on the front end, we can often reduce or eliminate actual transfusions on the back end.” At the same time, Ozawa says, better outcomes, fewer readmissions, shorter lengths of stay, and financial savings are realized.
“That’s the wide scope of patient blood management. It doesn’t really have a downside,” she says.
No one knows better than laboratory professionals that donor blood is a limited resource, she notes. “Fortunately, PBM programs focus on protecting, preserving, and optimizing the health of this most precious resource—the patient’s own liquid organ”—often making it unnecessary for laboratory professionals to “police” the blood supply.
Still, it’s hard to get patient blood management to the top of the hospital’s agenda, Ozawa says.
“We no longer encounter hospitals that say, ‘Well, this is unimportant.’ But they may say, ‘We don’t have the resources to build an organized program now because we’re worried we’re going to have potential downsizing or financial pressures because of Medicaid cuts.’”
“There are a trillion competing priorities,” she adds.
The latest guidance is more than 200 pages, and it comes four years after WHO issued its first and briefer guidance on PBM.
“We hoped to get attention from different health leaders, whether they be governmental or clinicians or others, to say this is important,” Ozawa says of the 2021 guidance.
The 2025 document provides two aids: a pathway for the rollout of PBM on a national/jurisdictional scale and a PBM toolkit for specific populations and diverse resource levels. Each toolkit addresses the management of anemia and iron deficiency, blood loss and bleeding, and coagulation disorders and abnormal hemostasis. The three toolkits stratified by national income class include two main layers, one for strategies and one for resources.
In conversations about PBM in some parts of Asia, for example, Ozawa and others would hear, “‘That’s nice for all of you who live in rich countries. We can’t do anything about this here because we lack people, resources, drugs, devices.’ And the intention of the policy brief [issued in 2021] was to say, ‘Even if all you have is your eyeballs and the conversation you have with the patient, you can do something about patient blood management, because if the patient is alive, their liquid organ is alive too, so how do you protect it?’” It could be as simple, she says, as saying, “Tell me what you cook for your family.”
The aim at that time was to draw attention to patient blood management, Ozawa says, “and I think we accomplished that in many parts of the world.” They understood, she says, but then asked how and what to do.
“It’s one thing to say you should do something. It’s another thing to say, ‘How do you do it in my environment?’”
It’s for this reason that the latest document, which explains how to build a multidisciplinary program in various settings, is a “top-down, bottom-up approach,” she says. “We said, ‘Ministries of health, government health systems, you are pushing from the top down. And community health organizations, patient rights or patient advocacy organizations, you’re pushing from the bottom up. In the middle are medical schools, medical professional societies, medical journals, and others who can come on board. But all have responsibility.’”
In the U.S., Ozawa says, the tendency is to “jump to the donor.”
“We often hear about the need for more blood. ‘Let’s get more donors.’ But what about the demand side? If we’re doing the right thing on the patient side, we reduce the demand. Then maybe the supply can keep up,” she says.
The WHO guidance points to viscoelastic testing as a device to be considered, among other things. “Goal-directed therapy is always better than arbitrary judgment,” Ozawa says.
“Having data-driven opportunities really does change the game,” says Siyavash (Sia) Fooladian, MD, MPH, a cardiac anesthesiologist and medical director for acute care diagnostics at Werfen.
The Food and Drug Administration approved Werfen’s Rotem Sigma thromboelastometry system in 2022.
Viscoelastic testing allows for real-time visualization of clot formation and dissolution during low shear rate blood flow.
Dr. Fooladian describes himself as passionate about viscoelastic testing. “There is great satisfaction in having data to drive clinical decisions and allow for the utmost care for patients,” he says, adding, “Instead of blindly transfusing, we’re using data and goal-directed therapy.”
WHO’s 2021 guidance “made a moral and economic case for PBM and offered high-level recognition,” he says, “whereas this new guidance is more of a how-to manual that pushes implementation models and provides three different toolkits based on the resource level of a country or institution.” These toolkits list viscoelastic testing as an essential device, he says, for different resource tiers above low income.
The guidance also emphasizes that blood is a scarce resource and should be treated as an organ, Dr. Fooladian says. “With the global burden of anemia, of more than 3 billion people suffering from impaired blood health, we need to focus on treating this as a systemic problem and implement strategies at institutional levels to promote blood health and conservation as the model for the future.”
Viscoelastic testing goes hand in hand with PBM, he says, and the use of both is increasing in the United States. “Penetration has been modest and growing,” he adds.
The pandemic underscored the blood product supply problems, Dr. Fooladian notes, “and shed more light, emphasis, and education on patient blood management, not just for intraoperative uses but also for dealing with anemia management preoperatively and postoperatively. So blood management has gotten a lot more optics on it.” In recent years, too, viscoelastic testing has been supported by such organizations as the Society of Cardiovascular Anesthesiologists. “So PBM is evolving and growing with higher education and greater emphasis on it in the U.S.”
Says Ozawa, “If we can get the point across that blood is an organ and we need to give it the same respect we give to every organ, which is taking care of it before it has a problem, then we avoid half of these conversations around transfusion.”
For some, the initial capital to implement PBM is a barrier, as is organizing a program, Dr. Fooladian acknowledges, but the health economics are clear. “Yes, there is a cost, but in the long term, there’s a significant savings and patient outcome improvements.” The need now is to continue to educate those in all hospitals, including those of all sizes at the community level, where costs can be “a little more prohibitive than for a large academic institution over the course of implementation.”
Though a smaller hospital may have fewer clinical services than a large academic center, PBM can be applied in all settings, says Ozawa, who works on PBM implementation with large academic hospital systems.
Another barrier to adoption for some institutions has been their internal IT solutions, Dr. Fooladian says, “and we try to help them with that.”
He hears from some that the viscoelastic assay results are received in the OR after the physicians have made their transfusion decision. Werfen’s Gemweb Live connectivity makes possible real-time access to the graphs as the samples are run, no matter where they’re run, whether in the laboratory or not. “As an anesthesiologist, we always like to have it at the point of care where we can walk over and see it, but I know there are bigger considerations from the lab directors, and we work with them hand in hand to see what the best solution is to make sure it’s useful for timely clinical decisions.”
The preference today among anesthesiologists tends to be to bring it “more to the point of care,” he says, but it is institution specific and laboratories, too, have logistic and other reasons for their preferences.
“They are the experts in terms of the devices and the QC.”
And they are the “champions” for PBM programs, having convinced the hospital administration it’s important, he says, but also creating the algorithms in conjunction with anesthesia departments and educating others and helping to track the metrics.
“They’re the support and thought leaders who help implement PBM programs,” Dr. Fooladian says.
As stewards of the patient’s blood for testing and of blood for transfusions, laboratories are “the essential partners at the table,” Ozawa agrees.
As to the state of PBM programs today, Ozawa says she and others are of the view that it’s time to ditch one word: “When we say patient blood management programs, we feel like we shouldn’t use the word program anymore. It should just be part of the fabric of what we do.”
Valerie Neff Newitt is a writer in Audubon, Pa.