A number of pharmacologic agents exist which may reduce, or completely eliminate, the need for transfusion. These drugs can help conserve scarce blood products and reduce the risk of adverse events associated with blood transfusion. Erythropoetin is a therapeutic option for chronically anemic patients in lieu of red cell transfusion. Antifibrinolytics may reduce blood usage, especially in extensive surgeries such as liver transplantation and cardiac bypass surgery. In the setting of trauma and massive transfusion, recombinant activated factor VII (rVIIa) has shown some success in reducing transfusion requirements. While these agents have a great potential to reduce blood utilization, they are not a panacea. Not all patients will respond to treatment and there is some risk for adverse events with use of these agents.