762 patients scheduled for primary hip or knee arthroplasty were randomized to an early-assessment pathway with point-of-care hemoglobin screening at the time of surgical consent or usual preoperative care with anemia assessment at the standard preoperative clinic visit. The outcomes of interest were feasibility and process measures, including pathway compliance, preoperative blood optimization clinic (PBOC) utilization, anemia optimization delivered, changes in hemoglobin following optimization, and preoperative hemoglobin at surgery. Other outcomes included pulmonary embolism, clinically significant bleeding, and reoperation for infection within 90 days postoperatively. Outcomes were assessed from referral through surgery and up to 90 days after surgery. Overall, the results of the study revealed that early anemia screening was feasible, achieved high pathway compliance, increased referrals for anemia optimization, and resulted in greater hemoglobin improvements among treated patients. However, preoperative hemoglobin levels and 90 day complication rates were similar between groups. These findings suggest that early identification and treatment of anemia can improve optimization processes without delaying surgery, although a clinical outcome benefit was not demonstrated.