OBJECTIVES: To assess appropriateness of anemia management in order to optimize BT during MO METHODS: Hip (HA) and knee arthroplasty (KA) are frequently associated with high volumes of blood loss. When those surgeries are elective, it is possible, with adequate pre-operative management, to decrease blood transfusion (BT). A retrospective study was conducted in a single French centre on consecutive cases of patients undergoing elective MOS in 2009. Criteria to evaluate optimization of BT were: transfusion rate, BT or no BT, according to international guidelines, optimal BT rate according to potential adequate anemia treatment (ESA, oral or IV iron) and administration of tranexanic acid. RESULTS: Sixty cases of MOS patients were included with 38 females and 22 males. 40 and 19 patients had undergone HA and KA, respectively. 55 patient charts were sufficiently documented to be evaluable. The mean delay for pre-operative consult was 32 days with a minimum of 5 days. According to hemoglobin value recorded and potential blood loss estimated during this visit, it was possible to predict that (in the absence of pharmacological treatment) 18 patients over 55 would be transfused during surgery. Among the 37 patients with no predictable BT, 3 were nevertheless transfused. Among the 18 patients with predictable BT, 14 were not transfused (10 were treated with ESA and 14 with IV iron) and 4 patients (not treated with ESA or iron) transfused. CONCLUSIONS: Anemia management before MOS could decrease BT during hospitalisation. Current medical practice assessment in a single French centre showed that in 32% of the patients anemia should be treated prior to hospitalisation. Among these patients, one out of 5 was not adequately treated with ESA and/or iron and was finally transfused. Approximately half of the BT could be avoided in this centre, which has already a low blood transfusion rate (13%).