Blood transfusion is a lifesaving medical therapy that was first done successfully in 1818 but has been routinely used in healthcare settings since the twentieth century. It remains a common and essential procedure among hospitalized patients. The decision to transfuse blood components is influenced by various factors, including a thorough assessment of the clinical condition and the options presented to the patient. Religious beliefs, personal preferences, and a growing awareness of the risks associated with transfusion have driven the development of strategies to minimize or avoid it altogether. As a result, the preference not to transfuse has led to the exploration of alternative options and complementary therapies. The implementation of patient blood management programs in many hospitals—along with a decline in the number of altruistic blood donors—has increased interest in alternatives to transfusion. These alternatives include the use of a patient’s own blood (autologous donation), intravenous iron therapy, and medications that stimulate bone marrow to enhance red cell and platelet production. Additional strategies involve the use of antifibrinolytics, vitamin K, and coagulation factors. Although artificial oxygen carriers are currently under development, none have yet been approved for clinical use. During the 1980s and 1990s, preoperative autologous donation emerged as a safe alternative to allogeneic transfusion. This approach allowed for the collection of a patient’s own blood prior to surgery. Over time, additional autologous techniques were developed, including intraoperative blood collection and cell salvage during surgery—practices that continue to be used in specific clinical scenarios today.