Malaria infection in humans by Plasmodium species is associated with a reduction in haemoglobin levels, frequently leading to anaemia. Plasmodium falciparum causes the most severe and profound anaemia, with a significant risk of death. This cannot be explained simply by the direct destruction of parasitized red blood cells at the time of release of merozoites, a process shared by all these species. In this review, Clara Menendez, Alan Fleming and Pedro Alonso focus on recent advances in our knowledge of the pathophysiology, epidemiology, management and prevention of anaemia from falciparum malaria.