Inclusion Criteria:  Adult patients presenting for elective cardiac surgery  Surgical procedures to include:  Redo surgery Adult congenital heart disease surgery (ACHD) Aortic surgery including aortic surgery requiring deep hypothermic circulatory arrest  Exclusion Criteria:  low risk cardiac surgery cardiac surgery not requiring cardiopulmonary bypass baseline anemia (Hgb < 13 for men and 12 for women) post-dilution Hct < 21-24 (basis for this is increased risk of AKI on CPB with Hct 21-22) preop treatment for anemia high-risk ischemia lesions (critical left main, multi-vessel disease, active/recent chest pain, unstable angina, presence of a balloon pump, recent history of myocardial infarction (MI) either non-ST elevation MI (NSTEMI) / ST-elevation MI (STEMI), regional wall motion abnormalities on echo) low left ventricular systolic function (LVEF < 35-40%) - decompensated heart failure Hypertrophic obstructive cardiomyopathy (HOCM) patients with significant left ventricular outflow tract (LVOT) gradients history of recent blood transfusion history of recent gastrointestinal (GI) bleed patient refusal to participate in the study severe aortic stenosis (AS) with reduced LVEF pulmonary hypertension underlying significant liver disease impairing synthetic function (elevated PT/INR or PTT) at baseline clotting disorders, inherited or acquired or iatrogenic coagulopathy (i.e. thrombocytopenia, pancytopenia) baseline chronic kidney disease (CKD) stage 3/above or End-stage renal disease (ESRD) +/- hemodialysis hemodynamically unstable patients including sepsis/recently treated sepsis preoperative extracorporeal membrane oxygenation (ECMO) or high suspicion for postoperative ECMO emergent cases