The transfusion of components made from human blood carries a small risk to the recipient. Pre-operative preparation, ensuring that the patient is not anaemic before surgery, is important to ensure that blood is not transfused unnecessarily. This article highlights that pre-operative anaemia is often not effectively managed in patients presenting for elective total hip replacement surgery, putting them at risk of unnecessary transfusion. A national comparative audit conducted by the authors suggests that there is a role for nurses who manage pre-operative assessment clinics to ensure that patients with anaemia are managed effectively before surgery. Nurses managing these clinics have an opportunity to decrease the need for peri-operative transfusion. The management of patients attending pre-operative assessment clinics should be reviewed to ensure that mechanisms are in place to allow the identification, investigation and treatment of anaemia. [ABSTRACT FROM AUTHOR]