Aim and background: Jehovah's Witness (JW) religion is a proselytizing Christian movement. They have strong religious beliefs retrieved from a strictly literal interpretation of passages in the Bible forbidding the “eating” of blood as there is the fright of losing eternal life. They refuse to accept homologous or autologous whole blood and blood products, even in case of emergency, to prevent morbidity and mortality. Case description: We discuss the successful use of cell saver in JW patients presenting with multiple fibroids and heavy bleeding undergoing total abdominal hysterectomy with bilateral salpingectomy with expected blood loss of 1.5–2 L under general anesthesia with epidural analgesia. Proper consent and preoperative planning with an experienced team is essential. Conclusion: To work in the window of providing a bloodless surgery under the circumstances of the legal and ethical issues of JW is challenging. Proper planning is needed to handle the available limited options to manage intraoperative blood loss. Clinical significance: Preoperative counseling to discuss and understand JW's religious beliefs and accordingly tailoring the anesthesia plan and surgical interventions is of legal importance.