Acute normovolemic hemodilution was described to be useful as a blood conservation strategy more than 25 years ago, yet seldom is practiced today. The benefit of acute normovolemic hemodilution is perceived to be modest and the technique is not taught in anesthesia or surgery training programs. Acute normovolemic hemodilution is an autologous blood procurement strategy that is superior to the predeposit of autologous blood for several reasons: Acute normovolemic hemodilution is less costly, with an average cost of $25 per unit compared with $175 per unit predonated; and acute normovolemic hemodilution units are reinfused to patients before the patient leaves the operating room, so that the units need not be tested and there is no possibility of administrative error. Emerging clinical studies now show that acute normovolemic hemodilution is equivalent to predonated autologous blood in reducing allogeneic blood exposure in patients undergoing elective surgery.