© 2018 Elsevier Inc. All rights reserved. Blood management is a multidisciplinary initiative with roots in evidence-based medicine. Since Jehovah's Witnesses do not accept most blood products, we have known for many years that patients could be safely treated without transfusion. However, it was not until the publication of the transfusion requirements in critical care (TRICC) trial in 1999 that we had evidence to back up the theory that a restrictive transfusion approach was not inferior to a liberal approach and for some patients, was actually superior. Additionally, studies on the side-effects of transfusion (e.g., increased risk of sepsis and alloimmunization) provided more evidence for using the least amount of blood as possible for each and every patient. Thus, patient blood management programs (PBM) should be an essential part of any hospital's transfusion medicine service. This chapter focuses on the evidence behind PBM, the safe triggers that have been established, the many ways that hospitals can reduce blood usage and wastage, and the challenges involved in both academic and community-based PBM initiatives.