A 62-year-old, female, African American, Jehovah’s Witness experienced bilateral and simultaneous vision loss 2 days after hip arthroplasty. Her 5-hour supine hip replacement surgery resulted in 1 L of blood loss; given her religious status, she refused replacement blood products. Her hemoglobin was 6.3 g/dL preoperatively and 4.7 g/dL postoperatively. The etiology of her preoperative anemia was not known. Her lowest postsurgical blood pressure was 75/45 mm Hg. Her hypotensive medications were discontinued, she was kept in Trendelenburg position, and was treated with intravenous (IV) iron and darbepoetin alfa.