Revision total hip arthroplasty places tremendous demands on the patient, surgeon, and healthcare system. The substantial reconstructive work performed can easily lead to long surgical durations and consequently, large blood volume losses. Host factors inherent to elderly patients such as fragile vasculature, osteopenia, anticoagulant medication, and clotting dysfunction can exacerbate bleeding. Additionally, common risk factors for revision THA in younger patients such as morbid obesity, muscular habitus, joint stiffness, and post-traumatic deformities are often present and require larger dissections and surgical times, which can cause substantial blood loss. Comprehensive strategies, including preoperative assessment of EBL risk, optimization of patient risk factors, meticulous intraoperative techniques, and postoperative care, play crucial roles in minimizing blood loss and reducing the need for allogeneic transfusions. The use of perioperative TXA and patient symptoms and risk factor-based transfusion triggers can markedly decrease unnecessary allogenic transfusions.