With a prevalence of >30%, anemia is the most common extraintestinal complication of IBD. It impacts upon individual wellbeing, physical and mental performance, and, when severe, leads to hospitalization. Still, doctors do not recognize it early, and thus treatment is delayed. The pathogenesis of IBD-associated anemia is complex and goes hand-in-hand with iron deficiency, often combined with anemia of inflammation. International guidelines recommend regular screening for iron deficiency and anemia in IBD patients, with tests including full blood counts, C-reactive protein, and ferritin assessments. Further diagnostic workup is needed if iron deficiency or inflammation do not explain the cause of the anemia. Even in mild anemia, an adequate therapeutic response is warranted. Treatment goals are a sustained increase in hemoglobin and iron stores (for the prevention of the need for blood transfusions), a relief of anemia-related symptoms, and an improvement in quality of life. Iron deficiency may be substituted orally or intravenously. The use of oral iron preparations is limited to patients with mild anemia who tolerate oral iron therapy. The preferred route of iron supplementation in IBD is intravenous, as this does not carry the risk of potentiating IBD symptoms and provides fast iron repletion. Several studies have demonstrated that certain intravenous iron products are safe and effective. In cases of iron-refractory anemia, erythropoiesis-stimulating agents may improve the response. This review will emphasize the clinical impact of anemia in the setting of IBD and summarize the current state of the art in its diagnosis and management. Inflamm Bowel Dis Monit 2011;11(4):152–9.