Since the first successful human-to-human blood transfusion in 1818, transfusion medicine has undergone transformative advances including blood group discovery, storage technology, and rigorous donor screening. Today, allogeneic blood transfusion remains one of the most frequently prescribed interventions. However, growing evidence links transfusion to infection, transfusionassociated circulatory overload (TACO), transfusion-related acute lung injury (TRALI), transfusionrelated immunomodulation (TRIM), prolonged hospitalisation, and mortality. In parallel, global demographic shifts, particularly rapid population ageing, threaten the sustainability of donor supply, as older patients account for a disproportionate share of blood use. These concerns underscore the double-edged nature of transfusion— life-saving yet burdened by risks and vulnerabilities. Patient Blood Management (PBM), introduced in 2005, reframes transfusion practice from a product-centred to a patient-centred paradigm. Built on three pillars—early detection and treatment of anaemia, minimisation of blood loss, and optimisation of anaemia tolerance— PBM represents a multimodal, multidisciplinary, evidence-based strategy to enhance patient safety while reducing transfusion reliance. Large-scale implementations, such as in Western Australia, demonstrate that PBM reduces transfusion rates and hospital-acquired complications, shortens length of stay, lowers mortality, and achieves substantial cost savings. Despite global endorsement including by the World Health Assembly (2010) and the Frankfurt Consensus (2018), PBM adoption remains inconsistent, hindered by clinician resistance, resource constraints, and translation gaps between evidence and practice. This lecture highlights the rationale, progress, and unmet challenges of PBM, and argues that its future lies not only in clinical and economic value but also in addressing intellectual challenges: redefining anaemia, rethinking transfusion triggers, and extending PBM to encompass all blood products in the pursuit of personalised medicine and sustainable healthcare.