More than one-third of patients are anemic before surgery. Preoperative anemia is exacerbated by hospital-acquired anemia (HAA) and is associated with adverse outcomes including increase perioperative mortality, transfusion rates, and postoperative anemia. Specific patient populations at risk of HAA include infants, patients in the ICU, and those with indwelling lines. The most successful approach to minimize HAA and anemia at hospital discharge is multipronged, employing a combination of strategies. These strategies include but are not limited to avoiding waste and unnecessary phlebotomy, use of noninvasive monitors and pediatric-sized specimen tubes, avoiding indwelling lines and routine laboratory orders, and establishing evidence-based practice standards. Blood loss and phlebotomy volume measurements should be part of the daily intake-and-output (I&O) documentation. Regular education is essential and requires ongoing monitoring and practitioner feedback.