donation during the early years of the AIDS epidemic. The demand for autologous transfusion has decreased as patients have become less concerned over the safety of transfusion, primarily because of improved testing for viral agents such as HIV and hepatitis. Other concepts that spare blood transfusion Erythropoietin, the red cell production hormone, can reduce the need for transfusion in stable medical patients with cancer and premature newborn infants. It can also be used to reduce the need for allogeneic transfusion in surgical patients, with or without concomitant autologous collection. 18 19 Perioperative anaemia and blood loss can also be dealt with by reducing the amount of blood lost at surgery through improving mechanical haemostasis, using antifibrinolytics such as aprotinin, limiting phlebotomy to essential diagnostic tests, and using microsample laboratory techniques. 20 Autologous transfusions also form part of a new concept of blood management called bloodless medicine and surgery. 21 This includes the use of erythropoietin, surgical techniques that minimise blood loss, and drugs that inhibit fibrinolysis; greater degrees of anaemia are tolerated, and phlebotomy undertaken for diagnostic testing is minimal. 20 Some of these methods are neither technically demanding nor expensive and may be adaptable to medical practice in less developed settings. The excellent results obtained in patients who are Jehovah's Witnesses, who refuse allogeneic transfusions, and the potential advantage of using fewer transfusions in patients in critical care support the promise of this concept for allogeneic transfusion. 22 Competing interests: NB has received lecture honorariums and consulting fees from Ortho Biotech.

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