The Working Group on Cardiopulmonary Bypass and Extracorporeal Life Support of China National Center for Cardiovascular Quality Improvement presents evidence-based guidelines on patient blood management for adult cardiac surgery under cardiopulmonary bypass. These guidelines aim to promote patient blood management programs, reduce blood loss and allogeneic transfusion, and improve patient outcomes. The Guidelines Panel includes multidisciplinary experts. Based on prior investigation and the patient, intervention, comparison, outcome (PICO) principles, thirteen questions from four aspects were selected, including priming and fluid management during cardiopulmonary bypass, anticoagulation and monitoring during cardiopulmonary bypass, peri-cardiopulmonary bypass blood product infusion, and autologous blood infusion. Systemic reviews of the thirteen questions were performed through literature research. Recommendations were generated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and reviewed and refined by all the Guideline Panel members. A total of 19 recommendations were finally approved after five expert meetings between 2023 and 2024. By implementing these recommendations, perfusionists and medical staff involved in cardiac surgery can optimize patient blood management, effectively decrease allogeneic blood transfusion rates, minimize perioperative bleeding, and ultimately improve the prognosis in adult patients undergoing cardiac surgery with cardiopulmonary bypass.