INTRODUCTION: The prevalence of anemia in inflammatory bowel disease (lBD) ranges from 6% to 74% and about 25% may develop moderate to severe anemia. It is not uncommon to treat anemia in IBD patients with red blood cell (RBC) transfusions. Previously it was shown that IBD with anemia is associated with a prolonged hospital stay, higher morbidity, and mortality rates. Prolonged length of stay by itself increases the risk of hospital-acquired infections including Clostridioides difficile infection (CDI). In addition, allogeneic RBC transfusions are associated with infections due to the risk of contamination and immunomodulation caused in the recipients due to the antigenic challenge. Not many studies were published on the association of CDI with RBC transfusions in IBD. Our objective is to assess the risk of acquiring CDI in anemic IBD patients treated with RBC transfusions. METHODS: We performed a population-based study using IBM EXPLORYS, a HIPPA-enabled platform that includes over 65 million patient data from multiple hospitals. A cohort of anemic IBD patients was identified and stratified into 2 groups i.e. who received and who did not receive RBC transfusions. CDI prevalence was calculated and demographic characteristics, exposure to antibiotics, and immunosuppressive treatment were compared. Chi-square with a significant P-value set at 0.05 was used for comparison between the groups. RESULTS: Of the total 319,400 IBD patients, 105,290 had anemia (33%) and 18,170 with anemia received RBC transfusions (17%). CDI prevalence in patients who received RBC transfusions was significantly higher than those who did not (19% vs. 7%, P < .00001).Furthermore, CDI prevalence in patients who received more than 2 RBC units (1900/8660, 22%) was significantly higher than those who received ≤2 units (1570/ 9510, 16.5%) (P < .00001). Significant differences in some demographic characteristics and higher recent antibiotic exposure in the group with no RBC transfusions were noted (Table). CONCLUSION: IBD patients with anemia, treated with RBC transfusions are more likely to develop CDI compared to those who did not receive any RBC transfusions. The risk of CDI is higher with more of RBC units. Restrictive transfusion strategies may decrease the risk ofacquiring CDI.Table 1.: Characteristics of IBD Patients with Anemia who Developed CDI with and without following RBC transfusions.