This study evaluated whether a combination of recombinant human erythropoietin (rHuEPO) and hemodilutional autologous transfusion could reduce homologous blood transfusion in 37 patients who underwent elective urological surgery. A single dose of 6000 IU rHuEPO was administered 2 weeks before operation to patients whose preoperative hemoglobin was less than 12.0 g.dl-1 (8.5-12.0 g.dl-1) (EPO group, n = 15) and compared these with control subjects whose preoperative hemoglobin was more than 12.0 g.dl-1 (non-EPO group, n = 22). Both hemoglobin and hematocrit levels after administration of rHuEPO in the EPO group increased significantly to the same levels as in those in the non-EPO group and remained at these levels. The mean volume of donated autologous blood was 980 g in the EPO group and 110 g in the non-EPO group. The mean surgical blood loss was 1330 g in the EPO group and 1120 g in the non-EPO group. No homologous blood transfusion was required in 80 percent of the cases in both groups: however, homologous transfusions were added to 3 cases in the EPO group and 4 cases in the non-EPO group whose surgical blood loss was over 2500 g. We conclude that the combination of preoperative rHuEPO treatment and hemodilutional autologous transfusion can reduce homologous transfusion during surgery in anemic patients.