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The therapeutic use of blood carries with it uncommon but potentially fatal complications. These well-documented risks have motivated a reevaluation of current transfusion practice. Recent information suggests that severe anemia may be safely managed without allogeneic blood products in a significant subset of patients. Bloodless medicine and surgery (BMS) programs have been developed mainly to meet the needs of Jehovah's Witness patients, but they also apply to non-Witness patients who desire to avoid or minimize their exposure to allogeneic blood products. This article reviews current and evolving concepts of anemia and blood loss management and reviews nonblood therapeutic options to minimize exposure to blood products.