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Aims: To ascertain the incidence of preoperative anaemia in a cohort of patients undergoing major gynaecological surgery in a tertiary Australian hospital over a two-year period and to investigate whether it is associated with an increased rate of transfusion or complications., Methods: Using the Western Australian Patient Blood Management (PBM) Data System, we obtained data for 843 women undergoing major gynaecological surgery over a two-year period at King Edward Memorial Hospital, Subiaco, Western Australia. We used regression analysis to investigate the relationship between preoperative anaemia, red cell transfusion, length of hospital stay and complications., Results: Preoperative anaemia was present in 18.1% of women and was associated with a significantly increased risk of receiving a red cell transfusion (OR = 5.74, P < 0.001). After adjusting for confounders, preoperative anaemia was not independently associated with increased complications or hospital length of stay, but receiving a red cell transfusion was (P < 0.001)., Conclusion: This study demonstrates preoperative anaemia is common in women undergoing elective major gynaecological surgery and is associated with increased red cell transfusions. A system to detect and treat anaemia prior to surgery in these patients should be implemented, and interventions should be evaluated to ensure they are effective., (© 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)