Conservative use of allogeneic red blood cell (RBC) transfusion is a growing trend in cardiovascular surgery. Recent advances in blood conservation measures have reduced, and in some cases eliminated, the need for allogeneic RBC transfusions in some of these patients. Reduced reliance on allogeneic RBC transfusion requires close collaboration among the clinical pathology, anesthesia, and surgery services managing the patient. Preoperative conservation measures include donation of autologous blood and treatment with recombinant human erythropoietin (Epoetin alfa). Meticulous surgical technique, moderate hemodilution, aprotinin, hemostatic techniques, blood salvage, and autotransfusion are intraoperative measures that can reduce blood loss. Postoperatively, even severe blood deficits can often be restored with adequate diet and rest and the use of actinics.