Margaret's story

Margaret needed a total hip replacement. She was worried about the risks of surgery, especially the possibility she may require a blood transfusion.

She decided to talk to her GP about it. Her GP did a thorough assessment looking in particular for evidence of anaemia and bleeding risk. Blood tests identified that Margaret had iron deficiency anaemia.

Having a low red cell count (haemoglobin level) increases the likelihood that a transfusion will be required. Low iron stores prior to surgery also means that it can be difficult to rebuild new red cells that are lost during surgery.

Margaret’s iron deficiency anaemia was investigated, with no sinister cause found.

Margaret's surgery was planned for three months time so she was able to successfully take oral iron tablets to boost her haemoglobin level back above normal.

Her GP arranged an appointment with the orthopaedic surgeon to further discuss options to minimise the need for a blood transfusion, such as the use of cell salvage and tranexamic acid – a medication shown to reduce blood loss in orthopaedic surgery.

Margaret was taking a non-steroidal anti-inflammatory, a medication that is known to increase the risk of bleeding, so a plan was put in place to change this to paracetamol two weeks prior to surgery.

Key information

  • Margaret was having surgery that may have required a blood transfusion.
  • She decided to be proactive and discussed her concerns with her GP.
  • Margaret’s GP was familiar with the principles of patient blood management and was able to start an action plan. He gave her a brochure and links to the website to help her understand what it was all about.
  • Margaret was diagnosed with iron deficiency anaemia which was investigated and treated.
  • Preoperative anaemia increases the likelihood that a transfusion may be required.
  • A plan to change her pain medication prior to surgery to reduce the risk of bleeding was put in place.
  • She also discussed cell salvage and tranexamic acid with her surgeon.
  • The surgeon also explained the benefits and risks of a blood transfusion, should one be required. He also informed her that the hospital has a single unit transfusion policy, so she would only be given the minimum amount of blood needed.
  • Margaret’s surgery was successful with no transfusion required.



Learn more about having a transfusion and how to avoid a transfusion.

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