Background: In sub- Saharan Africa a good number of pre-operative patients have deficit in packed cell volume or haemoglobin concentration as a result of multiple factors such as infections, poor nutrition and co- morbidities. For these reasons as work-up plan to optimize these patients prior to surgery there may be need for blood transfusion considering the benefit against the risk. Aim: To determine the prevalence of pre-operative aneamia and associated blood transfusion in surgical patients at the Rivers State University Teaching Hospital (RSUTH). Method: This was a six month cross sectional retrospective study of pre-operative patients at the Surgery and Obstetrics/Gynaecology department of the Rivers State University Teaching Hospital. The cut- off for aneamia was 33% in line with the World Health Organisation (WHO). Structured profoma was used to extract information from patients’ case notes and analysed using SPSS version 25. Result: The subjects for the study were 370, comprising of 146 (39.5%) males and 224 (60.5%) females. The mean age was 31 years. One hundred and ninety four (52%) were obstetrics and gynaecological surgeries while 176 (47.6%) were non-gynaecological surgeries. The commonest indication for surgery was ceasaren section representing 126 (34.1%) of the subjects. Two hundred and seventy two of the subjects (73.5%) had anaemia. One hundred and eighty four (67.9%) women had anaemia while 88 (32.1%) of the men were anaemic. Forty (10.8%) of the subjects required blood transfusion. Conclusion: The study revealed that prevalence of aneamia and blood transfusion amongst pre-operative patients at RSUTH were 73.6% and 10.8% respectively. Anaemia was highest amongst. Obstetrics and gynaecological patients compared to other surgical patients. Surgical patients should be optimized prior to surgery, one of such modalities to be employed is blood transfusion when the need arises.