The past decade has witnessed a revolution in transfusion therapy. Transfusion safety has increased many fold because of improvements in donor screening and testing. With increased knowledge of physiology, transfusionists have been able to use blood components with greater precision. Greater awareness of infectious and other complications has sparked the development and use of alternatives to allogeneic red cell transfusions. The most important of these alternatives are preoperative and intraoperative autologous transfusion and recombinant human erythropoietin. The effect of these approaches has been a marked reduction in the use of allogeneic blood. In many surgical and some medical settings, the need for allogeneic blood has been eliminated.