Anaemia is picked up on almost every arthroplasty work-up and acted on in a minority of them. It sits upstream of two separate infection risks: itself, and the transfusion it makes necessary.
So treat a low haemoglobin as a reason to move the operating date, not as a number to record. That means finding the cause rather than reflexively prescribing iron — iron deficiency in an older patient with a knee to replace still needs its source investigated, and a normocytic anaemia of chronic disease will not respond to iron at all. It also means allowing enough lead time: intravenous iron needs weeks, not days, to raise a haemoglobin.
Where the list is long and the pressure is to operate, the honest question is whether six weeks of delay to correct anaemia and stop smoking costs less than a periprosthetic infection. In most services it plainly does.
- Check haemoglobin early enough in the pathway that correction is still possible
- Investigate the cause of anaemia rather than prescribing iron by reflex
- Allow weeks, not days, for intravenous iron to work before the operating date
- Set a transfusion threshold in advance and document it, since transfusion carries its own association
- Use the same preoperative window for smoking cessation and glycaemic optimisation
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