Hypovolemic Phlebotomy to Reduce Blood Transfusions in Major Hepatic Resections

Inclusion Criteria: * Adult patients (≥18 years) * projected to undergo a major liver resection (≥3 segments resected or partially resected), a right posterior sectionectomy (segments 6/7), or central resection (4b/5) for any indication, or the resection of 1 or more segments in a known cirrhotic patient. Exclusion Criteria: * Age \<18 years * Preoperative hemoglobin \<100g/L * GFR clearance \<60mL/min * Abnormal coagulation parameters (not on warfarin and/or platelets count \<100 X10\^9/L) * Evidence of hepatic metabolic disorder * Active cardiac conditions: Unstable coronary syndromes; Severe valvular disease; and Myocardial infarction within 6 months prior to surgery * History of significant cerebrovascular disease: Patients with clinically-significant stroke/CVA within the past 6 months or severe carotid stenosis (defined as \>70%) * History of significant peripheral vascular disease: Non-revascularized with regular/ongoing claudication * Pregnancy * Refusal of blood products * Presence of active infection * Preoperative autologous blood donation * Planned intraoperative use of cell saver