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Preoperative anaemia is a recognised risk factor for major surgery. Approximately 30% of all preoperative patients are anaemic, and despite the risks it is often overlooked and unmanaged for reasons of insufficient time for intervention from referral to surgery or lack of management protocols. Screening data from a multicentre trial currently being undertaken and recruiting preoperative patients in the United Kingdom was used to assess these challenges. Results showed that between September 2013 and June 2015 screening data had been returned on 4979 patients, of those 415 (8.3%) met eligibility criteria. Of the ineligible patients 5 codes provided nearly 90% of the total exclusions for the trial: 44.9% due to Hb out of range for inclusion (either <90 g/L or >120 g/L); 17.7% not having major open surgery; 11% having laparoscopic surgery; 10.7% unable to randomise 10-42 days before surgery; 4.9% no Hb within 28 days. At least 18% of the patients screened were anaemic. Furthermore, up to half of reported screened patients were potentially anaemic, yet significant numbers of patients did not have adequate time for trial intervention or were without recent haemoglobin measurements. Rapid management of patients from referral to surgery is welcome, but can be a barrier to pre-optimisation of patients, which may reduce the benefit seen. Despite a significant prevalence of preoperative anaemia, current preoperative pathways inadequately facilitate its management for every patient.