An attractive alternative to banks is to do away entirely with borrowing: ensure the patient does not bleed; or if blood is lost, use the patient's own blood to replenish his volume. Uncontrollable bleeding, or even excessive blood loss, is an alarming experience for everyone patient, surgeon, and anaesthetist worse if supplies to replenish currency flow are limited, especially on short notice. Preoperative testing is done to identify and quantify bleeding propensities so that blood losses can be anticipated. Local haemostasis is an overworked term, but an often overlooked factor of haemostasis. It mimics vasoconstriction by ligature and clamp; mimics plug formation by cautery and the application of the finished products of coagulation most frequently in a matt or pledget-like form. Much improvement can be made in these techniques and will be discussed. Two factors conspire to thwart efforts at maintaining local haemostasis: the fragility of local tissues and vessels, and systemic haemostatic failure. Many plans have been formulated to identi~ the systemic propensity to bleed. In general, these plans advocate performance of the one-stage coagulation tests; prothrombin time, activated partial thromboplastin, and the thrombin time. These are amenable to routine performance. Two other tests, the bleeding time and a detailed history are not. They are labour intensive. They are also much more valuable than the routine tests. Schemes to detect systemic haemostatie abnormalities are expensive, and have as their chief value reassurance to the surgeon that all is well. It has been estimated that the cost of identifying a previously unknown, significant haemorrhage tendency is $1,200,000 (U.S.). Of course, reassurance is always an inestimable concept. The circumstances in which haemostatic screens should be used, their interpretation and use will be discussed extensively. Auto transfusion Homologous blood was transfused back into a patient as long as 150 years ago, but the procedure was not explored definitively until the needs of the Viet Nam conflict made themselves felt. Just as with the blood transfusion service development and the development of the other medical advances, war, pestilence, famine, and the fourth horseman, yield with tt~ek droppings the fertilization of medical advances. Five sorts of auto-transfusions are possible: preoperative, perioperative, intraoperative, postoperative, and postor intratraumatic. Preoperative deposit of autologous blood has advantages from many points of view. Problems of cross-matching or incompatible blood are obviated; and should the blood not be needed bythe patient it can be used as an analogous unit for others, if otherwise acceptable as a blood donation. The amount of anticipatory donations has been limited by the storage time of blood. Given a shelf life of about five weeks, the amount is restricted to about eight units. A welldesigned autologous blood programme also has provisions for the use of frozen blood, and this of course extends the shelf life indefinitely, allowing patients with peculiar blood problems to donate blood in anticipation of a future need. Intraoperative and postoperative auto-transfusions are the other important sources of personal credit. The problems associated with these methods are haemolysis, which produces haemoglobinemia; anticoagulation of the blood, which can also anticoagulate the patient and cause haemorrhage; microembolism formation of fat, tissue particles, aggregates of cells and of air; sepsis; the circulation of malignant cells and their possible enlodgement as metastasis; disseminated intravascular coagulation;