Blood Transfusion in Geriatric Hip Fracture Surgery: Anatomical and Clinical Perspectives, A Narrative Review

Blood transfusion is essential in the perioperative care of elderly patients with hip fractures. Because elderly people often have more than one health problem, the decision to transfuse blood is becoming more common and is always up for dispute. This narrative review examines the evidence regarding thresholds, results, and patient blood management (PBM) techniques. We integrate both anatomical and therapeutic perspectives on transfusion in hip fracture surgery. The literature review included PubMed, Scopus, and Google Scholar from 2000 to 2024. It found six main themes: the anatomical basis of perioperative blood loss, the evolution of transfusion thresholds, contemporary transfusion practices, strategies for blood conservation, clinical outcomes, and the gaps in the current evidence. There are six supporting tables that list the most relevant studies and show where there is still some dispute. In general, most stable patients seem to be safe with rigorous transfusion thresholds (about 8 g/dL). It appears that functional recovery is more influenced by comorbidity burden and surgical variables than by haemoglobin levels alone. Adding things like tranexamic acid, injectable iron, and structured PBM programs always makes it less likely that a person will need a transfusion. It is less likely that the results can be generalised because the trials were set up differently, the patients were different, and the results were reported differently. The analysis concludes by emphasising the immediate necessity for pragmatic, geriatric-focused trials. It also reminds doctors that they should make judgements about transfusions based on both the patient's anatomy and the clinical situation at the time.