This is the most common chronic anaemia encountered in hospital practice. ACD is caused by high levels of inflammatory cytokines and is seen in patients with inflammatory, infectious or malignant diseases as well as conditions such as diabetes and congestive heart failure. There is reduced production of red cells in the bone marrow, impaired utilisation of iron by red cell precursors and a ‘blunted’ response to erythropoietin (Epo). The anaemia is often mild and fluctuates with disease activity or response to treatment of the underlying medical condition. If patients are symptomatic from anaemia or Hb levels need to be improved before surgery (e.g. joint replacement in patients with rheumatoid arthritis), treatment with intravenous iron or an erythropoiesis stimulating agent (ESA) may be beneficial. ACD in patients with active rheumatoid arthritis or inflammatory bowel disease may be improved by treatment with monoclonal antibodies, such as anti-TNF, that reduce the inflammatory response.