AIM: Orthopaedic procedures such as total hip and total knee replacements carry a significant risk of post-operative anaemia, necessitating allogenic blood transfusions (ABT), and an increased hospital length of stay. Our aim was to investigate whether the implementation of a local protocol designed to detect and treat pre-operative anaemia resulted in reduced ABT rates and a shorter duration of length of hospital stay (LOS). METHOD: We retrospectively audited 683 patients undergoing primary hip and knee replacements. We collated data for all patients about hospital length of stay and blood transfusions received. Both descriptive statistics and univariate analysis were performed. RESULTS: 21.6% of the cohort within the study who were anaemic at pre-operative clinic had a significantly increased median LOS of 2 days (P < 0.001), and an increased packed red cell transfusion rate compared to non-anaemic patients (26.1% vs 2.21%, P < 0.001). However, treatment of pre-operative anaemia did not show any significant difference in transfusion rates compared to patients who did not receive corrective treatment. The median LOS was higher by 1 day in the treated group compared to the non-treated cohort (P = 0.005). CONCLUSION: There is significant evidence to suggest that pre-operative anaemia can increase LOS and increase the risk of requiring post-operative blood transfusions. However, anaemia should be regarded as a characteristic that can add to the outcome in a cumulative manner, as opposed to an isolated factor. Further research is needed on how to better manage pre-operative anaemia in order to improve patients’ outcomes.