title: Identification and treatment of anaemia in patients awaiting hip replacement.
abstract: BACKGROUND
  The correction of anaemia prior to total hip arthroplasty reduces surgical risk, hospital stay and cost. This study considers the benefits of implementing a protocol of identifying and treating pre-operative anaemia whilst the patient is on the waiting list for surgery.
  
  
  METHODS
  From a prospective series of 322 patients undergoing elective total hip arthroplasty (THA), patients identified as anaemic (haemoglobin (Hb) < 12 g/dl) when initially placed upon the waiting list were appropriately investigated and treated. Pre- and postoperative Hb levels, need for transfusion, and length of hospital stay were collated for the entire patient cohort.
  
  
  RESULTS
  Of the cohort, 8.8% of patients were anaemic when initially placed upon the waiting list for THA and had a higher transfusion rate (23% versus 3%; P < 0.05) and longer hospital stay (7.5 days versus 6.6 days; P < 0.05). Over 40% of these patients responded to investigation and treatment whilst on the waiting list, showing a significant improvement in Hb level (10.1 g/dl to 12.7 g/dl) and improved transfusion rate.
  
  
  CONCLUSIONS
  Quantifying the haemoglobin level of patients when initially placed on the waiting list helps highlight those at risk of requiring a postoperative blood transfusion. Further, the early identification of anaemia allows for the utilisation of the waiting-list time to investigate and treat these patients. For patients who respond to treatment, there is a significant reduction in the need for blood transfusion with its inherent hazards.
authors.affiliation: Department of Trauma and Orthopaedics, The Royal Surrey County Hospital, Guildford, Surrey, UK. benedictrogers@hotmail.com
authors.forename: B A
authors.initials: BA
authors.lastname: Rogers
authors.forename: A
authors.initials: A
authors.lastname: Cowie
authors.forename: C
authors.initials: C
authors.lastname: Alcock
authors.forename: J W
authors.initials: JW
authors.lastname: Rosson