Preoperative anemia is an independent risk factor for allogeneic blood transfusion in patients undergoing major orthopedic surgery (MOS) whereas hematinic deficiency can delay the recovery from postoperative anemia. Both conditions can, however, be corrected before elective procedures are undertaken. We therefore evaluated the prevalence of anemia and hematinic deficiencies in MOS patients. Demographic and laboratory data were gathered from all MOS patients from a single institution between January 2001 and December 2002. A total of 715 patients (483 women/232 men) entered the study. According to WHO criteria, the prevalence of anemia was 10.5% and increased with age, without gender-related differences. Preoperative hemoglobin was < 13 g/dL in 19.4% of patients, and the prevalence of hematinic deficiencies was 33% for iron, 12.3% for vitamin B12 and 3% for folate. In anemic patients, there were 30.8% with hematinic deficiency anemia (20% with iron-deficiency anemia), 30.8% with anemia of chronic disease and 38.4% with anemia of mixed or indeterminate cause. The prevalence of anemia, as well as of hematinic deficiencies, is high in MOS patients. Therefore, whenever possible, patients undergoing MOS should be assessed early enough to allow for proper investigation and treatment prior to the scheduled procedure.