Preoperative preparation and intraoperative techniques to minimize blood loss comprise standard therapy for the patient who refuses blood products on religious grounds. The severely anemic postoperative patient presents a particular problem in dealing with oxygen transport and consumption. The management of a Jehovah's Witness with a hematocrit of 6.6% is presented. Oxygen consumption (VO2) was decreased 30-50% by the use of body surface cooling, neuromuscular blocking agents, and narcotic-barbiturate administration.