Background <p>This study aimed to investigate the relationship between anemia, stroke severity, short-term prognosis, and imaging features of infarction.</p> Methods <p>The clinical features and imaging data of patients with anemia and acute ischemic stroke were retrospectively analyzed. All patients were divided into anemia and non-anemia groups, and according to the degree of anemia, they were divided into mild anemia group and moderate and severe anemia group. Stroke severity, short-term prognosis, and infarct lesion characteristics were compared between all groups.</p> Results <p>Among the 238 AIS patients, we found that the prevalence of anemia was 25.6%. There was significant correlation between the severity of anemia and NIHSS at admission (<i>P</i> = 0.01); The severity of anemia affected 90-day mRS (<i>P</i> = 0.01), and increased the length of hospital (<i>P</i> &lt; 0.01). In the moderate and severe anemia group, there were 16 cases of watershed infarction, 15 of cerebral infarction, and 14 of corona radiata and centrum semiovale infarction. Multiple infarcts were more significantly common in the moderate and severe anemia group (<i>P</i> &lt; 0.01).</p> Conclusion <p>The degree of anemia correlated with the severity of acute ischemic stroke. Furthermore, the severity of anemia was closely related to patient prognosis. The infarct sites of moderate and severe anemia were mostly in the cerebral lobe, corona radiata, and centrum semiovale, and the watershed area was prone to infarction with multiple infarction lesions, which may be related to tissue hypoperfusion.</p>