Patient Blood Management (PBM) is a multidisciplinary strategy to optimise patient outcomes by preserving autologous blood and reducing unnecessary transfusion. Although PBM initiatives exist worldwide, the consistency of national guideline recommendations remains unclear. This review compared international PBM programmes and explored reasons for variation.

A systematic review was conducted in accordance with PRISMA guidelines. In March 2024, Medline, Cochrane Library, and Google Scholar were searched for publications from the past 20 years, supplemented by governmental and institutional sources. Guidelines were assessed using the International Centre for Allied Health Evidence checklist. Laws, nationally implemented guidelines, or documents with ministerial involvement were included for a comparative text analysis if they addressed defined PBM elements, were freely accessible, and met quality criteria. The review was registered on PROSPERO and completed in 2025.

Forty national and institutional guidelines were analysed. The greatest variability concerned strategies to reduce diagnostic blood loss. In contrast, most other PBM domains showed substantial agreement, particularly regarding restrictive transfusion strategies, most defined by a haemoglobin threshold of 7 g dl⁻¹ (22 guidelines) or lower (nine guidelines). National standardisation was frequently absent, even in countries with advanced hospital-level PBM programmes. Guidance for acute care and intensive care was usually issued by specialty societies rather than national authorities; prehospital recommendations were scarce.

National guidelines on Patient Blood Management remain fragmented, as comprehensive policy frameworks and multidisciplinary coordination are lacking. Greater harmonisation and structured change management are required to support wider global adoption of PBM.