Though hemorrhoids commonly cause minor gastrointestinal bleeding, major hemorrhage requiring blood transfusion is believed to be rare. We sought to identify the prevalence and risk factors for preoperative transfusion in surgical hemorrhoidectomy patients.

Patients undergoing surgical hemorrhoidectomy at a single institution (2012–2017) were evaluated for preoperative bleeding requiring transfusion. Bivariate analysis compared patients requiring transfusion to those who did not, and multivariable analysis evaluated for independent risk factors for transfusion.

Out of 520 patients, 7.3% experienced hemorrhoidal bleeding requiring transfusion, and 80.6% reported bleeding. On multivariable analysis, the use of either an anticoagulant or non-aspirin antiplatelet agent was associated with transfusion (OR 3.08, p = 0.03). Patients requiring transfusion had extensive preoperative workups, including colonoscopy (94.7%), flexible sigmoidoscopy (7.89%), upper endoscopy (50%) and capsule endoscopy (26.3%).

Bleeding requiring transfusion is an under-reported complication of hemorrhoids. Increased recognition could lead to expeditious surgical treatment and less costly diagnostic workup.

Summary: Preoperative bleeding requiring transfusion from hemorrhoids is believed to be rare. However, 7.3% of patients undergoing surgical hemorrhoidectomy were found to require transfusion preoperatively. Anticoagulant and non-aspirin antiplatelet agent were independently associate with preoperative transfusion. These patients had extensive, potentially unnecessary preoperative diagnostic workups.