Acute normovolemic hemodilution (ANH) may function to preserve the patient’s red blood cell (RBC) mass, reduce the need for allogeneic blood transfusion, and lower donor exposure when used in conjunction with other blood conservation strategies as part of a robust PBM program. It may be essential in blood loss cases when the patient has a rare blood type. ANH is most effective when the surgery is associated with significant blood loss and the patient can tolerate a relatively large amount of blood withdrawal. Some safety concerns include hemodynamic instability due to intolerance of the volume withdrawn, dilutional anemia or coagulopathy, and fluid overload. Performance of ANH is technically involved, thus institutional ANH protocols, education, and experienced pediatric practitioners are crucial for patient safety.