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Preoperative anaemia confers a higher intraoperative and postoperative risk of complications on a patient. Preclinical anaemia is defined as a patient with laboratory indices of anaemia but without any of the symptoms. The patient population who undergo total hip replacement (THR) are elderly and are more likely to fall into this category. Our aim was to assess the effect of preclinical anaemia on a patient's postoperative course.A prospective analysis of elective THRs performed over a 10-month period was carried out. Preoperative haematological indices were recorded and correlated with postoperative complication rates.A total of 225 elective THRs were included in the study. Patients with preclinical anaemia on admission had a higher incidence of postoperative infection and transfusion (p<0.001) and a longer postoperative inpatient stay. Preoperative iron supplementation in patients with preclinical iron deficiency anaemia resulted in a reduction in transfusion requirements (p=0.00125).Identification and treatment of patients with preclinical anaemia preoperatively may reduce postoperative infection and transfusion needs and result in a shorter inpatient stay.