Review ArticleTreating Preoperative Anemia to Improve Patient Outcomes After Orthopaedic SurgeryShanbhag, Satish P. MBBS, MPH; Solano, Mitchell A. MD; Botros, Mina A. MBBCH; Khanuja, Harpal S. MDAuthor Information From the Division of Hematology, Department of Medicine, The Johns Hopkins University (Dr. Shanbhag), the Department of Orthopaedic Surgery, The Johns Hopkins University (Dr. Solano and Dr. Khanuja), Baltimore, MD, and the Department of Internal Medicine (Dr. Botros), Flushing Hospital Medical Center, Flushing, NY. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Shanbhag, Dr. Solano, Dr. Botros, and Dr. Khanuja. Journal of the American Academy of Orthopaedic Surgeons: December 15, 2019 - Volume 27 - Issue 24 - p e1077-e1085 doi: 10.5435/JAAOS-D-18-00810 Metrics Abstract For patients undergoing orthopaedic surgery, preoperative risk modification and control of comorbidities can maximize safety and improve outcomes. Anemia is common among orthopaedic patients, and its prevalence increases with patient age. Although surgeons are well versed in intraoperative blood conservation, preoperative anemia treatment is often deferred to primary care physicians, who may not understand the importance of a thorough assessment and treatment. Orthopaedic surgeons should understand the causes and treatments of anemia to advocate that patients receive appropriate preoperative care. Mean corpuscular volume and reticulocyte count can help determine the cause of anemia and assess the bone marrow's ability to produce red blood cells. These values can be used to aid in diagnosis and treatment plans. Iron deficiency anemia, the most common type, is a microcytic anemia easily treated with iron supplementation. In cases of trauma, anemia can be related to acute blood loss and underlying conditions. Fracture patterns and preexisting comorbidities should be assessed. The role of intravenous iron supplementation in this setting has not been clearly shown. Patients needing urgent procedures that might involve substantial blood loss should receive transfusions if they have hemoglobin levels <8 g/dL or symptomatic anemia. Copyright 2019 by the American Academy of Orthopaedic Surgeons.