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This before-and-after study confirms that a standardised intraoperative blood conservation programme including expanded use of cell salvage, extensive adoption of acute isovolemic haemodilution and routine use of retrograde autologous priming is associated with a reduction in blood product transfusion and improved outcome. It is unfortunate that this programme did not include the detection and the management of preoperative anaemia, which is quite common in this high-risk surgical population.

– Philippe Van der Linden