Blood management has been defined as “the appropriate use of blood and blood components with a goal of minimizing their use.” (1) The US Food and Drug Administration and the blood industry promotes the appropriate use of blood through the Circular of Information for the Use of Human Blood and Blood Products, which states that “red cell-containing components should not be used to treat anemias that can be corrected with specific medications. …” (2) Despite these and other recommendations, (3) transfusion practices are still behavior based and result in unnecessary blood product use. (4-6) Although allogeneic transfusion is considered “safer than it has ever been,” (7) this level of safety has come at the price of increasing costs and decreasing supplies. In recent years, the role of blood transfusion in management of anemia has come into question. (8) Liberal versus restrictive transfusion strategies in euvolemic critical care patients who are not actively bleeding and who do not have ischemic coronary artery disease have shown that transfusion to higher levels of hemoglobin is not necessarily better. (9) Many reports of patients treated without transfusion for a variety of medical and surgical problems show that avoidance of allogeneic blood is safe and effective. (10) Strategies for managing acute, severe anemia continue to evolve, as the critical limits for tissue oxygenation remain poorly defined.