The patients, reported here, needed open heart surgery, but religion obliged them to refuse blood transfusion. Three of the four patients suffered from obstructive coronary diseases and one from mitral valvular disease, prevalently stenosis. All of them refused blood transfusions. One of the three patients presented, was refused by an other Cardiovascular Surgery Center because of his low blood values (Haemoglobin 9.2--Haematocrit 26.7). All these patients had been treated with subcutaneous injection of epoetin alfa 10,000 U twice a week and ferrous sulphate 525 mg three time a day per os, for three weeks before operation. Haemoglobin, haematocrit and reticulocytes values were controlled in pre, postoperative and at discharge. With this treatment the authors found haemoglobin and haematocrit values so increased to allow surgery without blood transfusion during and in the post operative period.