Blood loss is an inevitable consequence of surgery. We refer a case report of patient with high cardiac risk (ASA classification III), in which we used acute normovolemic hemodilution as a solely method for avoiding of allogenic blood transfusions. After starting general anaesthesia we removed 2 500 g of whole blood from patient with restoration of circulation volume by 1 500 ml of colloids and 2 000 ml of crystalloids. Retransfusion we started after 800 ml blood loss (transfusion trigger - Hct 0,20). The general blood loss was 3 500 ml during 6 hour and 40 minutes of operation time and next 880 ml in 48 hours postoperatively. The patient was the whole time hemodynamic stable, with mi nimal systolic blood pressure 100 mmHg and ending hematocrit value 0,26. To reduce the risk of anaemia and also the risk of allogeneic transfusion is the one of the basic part of the anaesthesia management of large urological procedures. This case demonstrated the effectiveness and safety of acute normovolemic hemodilution as a method for avoiding of allogeneic blood transfusion in patient with high anaesthesiological risk.

        Key words: acute normovolemic hemodilution - large blood loss - cardiac risk patient