Blood conservation during cardiac surgery is an area of considerable investigation and interest. Strategies that may decrease allogenic blood product exposure during cardiac surgical procedures are reviewed. The two strategies which were judged to be the most efficacious in reducing blood product exposure were autologous predonation and the use of aprotinin. Additional measures which favorably impact on blood product exposure are the use of recombinant human erythropoietin to enhance autologous blood donation, selective use of desmopressin acetate, salvage of the bypass circuit, the use of on-site laboratory testing and the establishment of transfusion guidelines based upon laboratory values. All other currently used strategies are either uner investigation, marginal in benefit, or unfounded.