Major orthopaedic surgery and high energy trauma are often responsible of acute bleeding. Long bones and pelvis fractures are correlated with increased blood loss. The final consequence of a mayor bleeding is hypovolemic shock. The reduced oxygen
tension of tissue could be responsible of heart attack, arrhythmia, ictus, multi organ deficiency. For these reasons, it is important to immediately recognize and correct all potential bleeding in order to avoid complications. In orthopaedics the elective treatments in the management of hypovolemia are different. Blood banks and allogenic blood components have had an important impact on operative treatment and health care worldwide. Erythropoietin has been shown in numerous studies to be effective in raising the preoperative hematocrit and reducing the need for allogenic transfusion in major orthopaedic surgery. Erythropoietin may be as good as or better than preoperative autologous donation. The aim of the present article is to describe a simple review of the literature based on our experience.