Autologous blood transfusion is an endorsed blood conservation strategy that has become widely practiced in elective surgical procedures. We review ten years' experience in this arena, along with emerging strategies designed to continue to minimize allogeneic blood exposure but reduce the costs associated with autologous blood procurement. We conclude that point-of-care autologous blood procurement (acute normovolemic hemodilution and intraoperative autologous blood salvage) can replace the predonation of autologous blood in surgical patients when transfusion medicine specialists, anesthesiologists, and surgeons develop a prospective, comprehensive approach to blood conservation.