A Prospective Randomized Trial of Acute Normovolemic Hemodilution (ANH) in Patients Undergoing Cytoreductive Surgery for Ovarian Cancer

Inclusion Criteria: * Adults (≥18 years) * BLOODS score ≥2 as calculated by surgeon * High preoperative suspicion (or diagnosis) of advanced primary epithelial ovarian, fallopian tube, or primary peritoneal carcinoma (stage IIIC or IV), as determined by CT or MRI of the abdomen/pelvis * Planned for exploratory laparotomy and primary or interval cytoreductive surgery * Preoperative hemoglobin concentration ≥10 mg/dl within 45 days of surgery * Patients scheduled for cytoreductive surgery, with or without other planned procedures o Note: Patients scheduled for only diagnostic laparoscopy should not be included Exclusion Criteria: * A history of active coronary artery disease o Patients with a history of coronary artery disease will be eligible if they have had a cardiac stress study showing no reversible ischemia and normal LV function within 45 days of surgery. * A history of cerebrovascular disease * A history of congestive heart failure * A history of uncontrolled hypertension * A history of restrictive or obstructive pulmonary disease * A history of renal dysfunction (Cr \>1.6 mg/dl) * Abnormal coagulation parameters (INR \>1.5 not on coumadin, or platelet count \<100,000 mcL) * Presence of active infection * Evidence of hepatic metabolic disorder (bilirubin \>2 mg/dl, ALT \>75 U/L in the absence of biliary tract obstruction) * Preoperative autologous blood donation within last 30 days or plan to donate autologous blood prior to surgery * Refusal to accept allogenic or autologous blood transfusion * Patients scheduled for cytoreductive surgery with planned Hyperthermic Intraperitoneal Chemotherapy (HIPEC)