ANH is a relatively cheap and logistically straightforward method of autologous transfusion which is attractive in that it may be applied to a wide cross-section of patients, many of whom will not be suitable for pre-deposit. There are, however, concerns about the safety of the procedure, and doubts have been expressed about its efficacy in reducing allogeneic transfusion requirements and, therefore, its cost-effectiveness. Assessment of the value of the procedure is hampered by the lack of large scale prospective, controlled trials. In the present state of knowledge it seems that ANH is most likely to be safe, efficacious and cost-effective when undertaken aggressively (target haematocrit < 0.20) in otherwise healthy, young patients undergoing elective surgery with large expected blood losses.