Roads travelled: The journey to Patient Blood Management at 35 years

Patient Blood Management evolved in recent years, focusing on the haematopoietic system as relevant to all disciplines of medicine. The allogeneic blood supply chain travels from donation, to fractionation, preservation, and storage, to therapeutic, established treatments, or prophylactics for a wide range of medical conditions. This supply chain 'connects' altruistic blood donors to patients in need, symbolising a 'gift relationship', emphasising the empathetic bond between donor and recipient. In 1988, the author proposed a paradigm shift in blood transfusion and, in 2005, introduced the term Patient Blood Management (PBM). PBM's origins are traceable to the late 19th century, when blood transfusion wasn't feasible for managing exsanguinating haemorrhage or critical anaemia. Landsteiner's discovery of the ABO blood groups firmly established blood component therapy into medical therapeutics. This article recounts the journey from a pre-blood transfusion era patient-centred approach, through the 20th century's blood product focus, and thenceforth back to the patient with the advent of PBM.