331 Hong Kong Medical Journal ©2020 Hong Kong Academy of Medicine. CC BY-NC-ND 4.0 ABSTRACT Patient blood management (PBM) is a patient- centred, multidisciplinary approach to optimise red cell mass, minimise blood loss, and manage tolerance to anaemia in an efort to improve patient outcomes. Well-implemented PBM improves patient outcomes and reduces demand for blood products. Te multidisciplinary approach of PBM can often allow patients to avoid blood transfusions, which are associated with less favourable clinical outcomes. In Hong Kong, there has been increasing demand for blood in the ageing population, and there are simultaneous blood safety and donor issues that are adversely afecting the blood supply. To address these challenges, the Hong Kong Society of Clinical Blood Management recommends implementation of a PBM programme in Hong Kong, including strategies such as optimising red blood cell mass, improving anaemia management, minimising blood loss, and rationalising the use of blood and blood products. Hong Kong Society of Clinical Blood Management recommendations for implementation of patient blood management Introduction Clinical blood transfusion remains an essential and irreplaceable part of modern medicine, either as an independent therapeutic modality or an additional support to other clinical therapies. Anaemia, a serious disease with a worldwide burden on both hospitalised patients and society, 1-3 is often managed with blood transfusion as part of the treatment. Without a reliable substitute, sourcing of the blood used in transfusion relies solely on donations from voluntary, non-remunerated blood donors. Because blood is a biological substance, it is impossible to completely eliminate adverse outcomes during and after transfusion. Worldwide, particularly in developed countries, the ageing of the population and emerging infectious diseases are the two most important and ongoing threats to the sustainability of the safe blood supply. Ageing populations tend to have increased numbers of complex surgeries and cancer treatments requiring increased blood transfusions. 4 In 2016, the mean per capital blood Hong Kong Med J 2020;26:331–8 https://doi.org/10.12809/hkmj208397 YF Chow *, Benny CP Cheng, HK Cheng, Betty Ho, CK Lee, SK Ng, Rita So, KC Tse, Cindy Tsui, Ryan Wan, Steven Wong, for the Hong Kong Society of Clinical Blood Management Limited use in high-income countries was 32 units of red cell components per 1000 population. Moreover, the most frequently transfused patient group is aged >60 years, accounting for up to 79% among these transfusions. 5 Infectious pathogens continue to emerge rapidly, which could adversely afect transfusion safety both directly (if the pathogen is transmitted through blood transfusion) and indirectly (if outbreaks reduce the pool of available donors). 6 Recent examples include the Zika virus outbreak in South America and the dengue, hepatitis E, and chikungunya virus outbreaks in Southeast Asia. 7 Terefore, maintenance of a sustainable and safe blood supply continues to be a challenging task that requires a substantial amount of efort and resources. Tere is evidence associating blood transfusion with less favourable clinical outcomes. 8,9 Tis evidence includes a higher incidence of recurrence in cancer surgeries, higher operative mortality, failure to rescue from sepsis, and other MEDICAL PRACTICE 1 YF Chow *, FHKAM (Anaesthesiology) 2 BCP Cheng, FHKAM (Anaesthesiology) 3 HK Cheng, FHKAM (Anaesthesiology) 4 B Ho, FHKAM (Anaesthesiology) 5 CK Lee, FHKAM (Medicine) 6 SK Ng, FHKAM (Anaesthesiology) 7 R So, FHKAM (Anaesthesiology) 3 KC Tse, FHKAM (Anaesthesiology) 8 C Tsui, FHKAM (Anaesthesiology) 6 R Wan, FHKAM (Anaesthesiology) 1 S Wong, FHKAM (Anaesthesiology) 1 Department of Anaesthesiology and OT Services, Queen Elizabeth Hospital, Hong Kong 2 Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital, Hong Kong 3 Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital, Hong Kong 4 Department of Anaesthesiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong 5 Hong Kong Red Cross Blood Transfusion Service, Hong Kong 6 Private Practice, Hong Kong 7 Department of Anaesthesia, Princess Margaret Hospital, Hong Kong 8 Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong * Corresponding author: yfchowhk@yahoo.com.hk