Anemia is one of the most common health conditions worldwide, affecting people of different ages and backgrounds. Although it is often perceived as a minor condition that causes “fatigue” or weakness, anemia may actually indicate an underlying health problem that requires proper investigation and appropriate treatment [1]. At the population level, anemia is a leading cause of disability worldwide. In 2021, it affected approximately 1.92 billion people and accounted for 52.0 million years lived with disability (YLDs), representing 5.7% of global YLDs. This burden is associated with substantial productivity losses and healthcare costs, with low- and middle-income countries, women of reproductive age, and children disproportionately affected [2,3].
Anemia is characterized by a reduced level of hemoglobin in the blood, resulting in a decreased ability to transport oxygen to the body’s tissues. Anemia can be classified into three broad categories according to its underlying mechanism: decreased red blood cell production, increased red blood cell destruction (hemolysis), and blood loss. It can also be classified as inherited or acquired, depending on its origin [4]. These categories may overlap, as some forms of anemia involve more than one mechanism. Iron-deficiency anemia is the most common type and occurs when the body lacks sufficient iron to produce adequate hemoglobin. Other causes include vitamin B12 or folate deficiency, chronic diseases, inherited conditions, and disorders affecting red blood cell production or survival. Blood loss can cause anemia directly and, when prolonged, may also lead to iron deficiency [5].
The symptoms of anemia can be mild and develop gradually. Common symptoms include fatigue, weakness, dizziness, headaches, shortness of breath, and difficulty concentrating [6]. This is one of the main reasons why anemia may remain undiagnosed for a long time. Many people become accustomed to feeling tired and attribute their symptoms to stress, a demanding lifestyle, or insufficient sleep [7].
Prevention and early diagnosis are therefore particularly important. A balanced diet, awareness of risk factors, and timely medical evaluation can contribute to the prevention and management of anemia. At the same time, it is vital to emphasize that iron supplements should only be taken on medical advice. Effective treatment requires identifying and appropriately addressing the underlying cause [8].
Anemia should not be regarded merely as a condition that causes tiredness. Raising awareness, promoting prevention, and seeking medical advice when symptoms persist are essential steps toward better health. Recognizing the signs of anemia can not only lead to timely treatment but may also help identify an underlying medical condition. In a world where the demands of daily life and stress often lead us to ignore our bodies’ signals, anemia serves as an important reminder that persistent fatigue should not always be dismissed as “normal” [9].
In this Special Issue, distinguished scientists discuss a wide range of topics related to hereditary anemias, including sickle cell disease and its association with the risk of thrombosis, as well as the management of iron-deficiency anemia in children and pregnant women, the most prevalent form of anemia worldwide.
Beyond anemia itself, thrombotic complications represent an important challenge in sickle cell disease. Tzanninis et al. (Contribution 1) explore this issue in a single-centre retrospective study of 46 patients followed between 1999 and 2024. Thrombotic events were documented in 26.1% of the cohort, while venous thromboembolism occurred in 17.4%. The authors examine clinical and treatment-related factors associated with thrombosis, highlighting the complexity of assessing thrombotic risk in this population. Their findings underscore the need for further research to guide effective prevention and management strategies.
Another important aspect of sickle cell disease is the variability in anemia severity. Dr Diamantidis et al. (Contribution 2) address an important and relatively underexplored clinical issue: the determinants of anemia severity in patients with sickle cell disease (SCD), particularly in a Mediterranean population in which HbS/β-thalassemia is common. The long-term follow-up and the availability of molecular data are important strengths. The reported association between β0-thalassemia alleles and lower hemoglobin levels is clinically interesting and may contribute to a better understanding of genotype–phenotype relationships in SCD.
Another interesting paper by Abbotts et al. (Contribution 3) discusses the pathophysiology, diagnosis and management of anemia of chronic disease (ACD) which is a common complication of chronic infectious, inflammatory, and autoimmune disorders, primarily resulting from immune-mediated iron sequestration and impaired erythropoiesis. Hepcidin plays a central role in its pathogenesis by restricting iron availability, while inflammatory cytokines also reduce erythropoietin responsiveness and shorten red blood cell lifespan. Erythropoiesis-stimulating agents and newer therapies, such as hypoxia-inducible factor prolyl hydroxylase inhibitors and hepcidin inhibitors, cytokine targets, carbon dots, androgens, and other therapies are emerging as possible treatment routes.
The development of blood transfusion has contributed significantly to advances in surgical procedures. However, blood supplies may be insufficient in an ageing population with declining blood donation rates, or during emergencies such as the COVID-19 pandemic, when donor attendance decreased. The narrative review by Ionescu et al. (Contribution 4) examines various approaches to perioperative anemia, strategies to minimize reliance on allogeneic blood transfusion (ABT), and alternatives within the patient blood management (PBM) paradigm. Evidence supports the use of iron therapy, erythropoiesis-stimulating agents, antifibrinolytic strategies, and blood conservation techniques to reduce transfusion requirements and improve clinical outcomes.
In addition, effective treatment of iron-deficiency anemia during pregnancy requires careful consideration of both maternal and fetal well-being. In this context, Polese et al. (Contribution 5) evaluate intravenous ferric carboxymaltose in 105 women in the third trimester, reporting improved hemoglobin levels and few maternal adverse effects. Fetal well-being was assessed using cardiotocography before, during, and after the infusions, with all recordings classified as normal. These findings provide reassuring evidence regarding its use in this setting, although larger prospective studies are needed to confirm its safety.
Turning to iron-deficiency anemia in children, two complementary narrative reviews examine the selection and use of iron preparations. Alexiadou et al. (Contribution 6) provide a practical overview of prevention and oral treatment, discussing differences in efficacy, tolerability, cost, and safety among available products. Leone et al. (Contribution 7) expand this discussion by examining formulation-specific trade-offs, lower-dose and alternate-day regimens, and the role of intravenous iron when oral therapy is ineffective or unsuitable. Both reviews emphasize that oral ferrous salts remain a first-line option, while alternative formulations may improve tolerability and adherence in selected patients. Together, these contributions highlight the importance of tailoring treatment to each child’s needs and the need for further comparative pediatric studies.
While the preceding reviews focus on iron deficiency, nutritional anemia may also arise from less common deficiencies that pose diagnostic challenges. Chun et al. (Contribution 8) illustrate this through a case of zinc-induced copper deficiency in an 18-year-old patient presenting with anemia and neutropenia after prolonged high-dose zinc supplementation. Their report draws attention to bone marrow abnormalities, including vacuolated hematopoietic precursors and occasional ring sideroblasts, which may resemble myelodysplasia. By highlighting the interference of excess zinc with copper absorption, this contribution underscores the importance of a detailed dietary and supplement history and consideration of copper deficiency in unexplained cytopenias. Recognizing this potentially reversible cause can help avoid misdiagnosis and guide appropriate treatment.
It is well known that thalassemia is the most prevalent monogenic hereditary anemia worldwide with high morbidity and mortality, especially in underdeveloped countries. Nowadays, important progress has been made in transforming the disease from a fatal to chronic one. Given high treatment costs, genetic counselling is a vital component in successful prevention [10]. Angastiniotis et al. (Contribution 9) discuss how genetic counselling should be an integral part of hematology services to improve thalassaemia prevention and reproductive decision-making.
In conclusion, we believe you will find this Special Issue both engaging and informative, as it presents an up-to-date overview of the most common types of anemia.
Author Contributions
E.V. and T.-M.V. are equally contributed in writing the Editorial. All authors have read and agreed to the published version of the manuscript.
Data Availability Statement
No new data were created or analyzed in this study. Data sharing is not applicable to this article.
Conflicts of Interest
The authors declare no conflicts of interest.
List of Contributions
- Tzanninis, R.; Vlachaki, E.; Lefkou, E.; Tsiara, S.; Theodoridou, S.; Vyzantiadis, A.; Matsagkas, M. Interplay Between Sickle Cell Disease and Thrombosis: A Single Center Experience of Pathophysiology and Potential Risk Factors. Hematol. Rep. 2025, 17, 45. https://doi.org/10.3390/hematolrep17050045.
- Diamantidis, M.D.; Argyrakouli, I.; Betsi, E.; Roupakia, A.; Krestinidi, P.; Palassopoulou, M.; Zayed, O.; Karaloizos, L.; Manafas, A. Anemia in a Cohort of Greek Patients with Sickle Cell Disease: Clinical Insights and Therapeutic Challenges. Hematol. Rep. 2026, 18, 75. https://doi.org/10.3390/hematolrep18050075.
- Abbotts, K.; Sriskandarajah, P. Anemia of Chronic Disease: Pathophysiology, Diagnosis and Management. Hematol. Rep. 2026, 18, 48. https://doi.org/10.3390/hematolrep18040048.
- Ionescu, A.; Mihăilescu, A.; Dumache, R.; Capcelea, A.; Turceanu, A.D.; Albulescu, N.; Săndesc, M.A. Perioperative Anemia, Transfusion Practices, and Patient Blood Management: Lessons from the COVID-19 Pandemic. Hematol. Rep. 2026, 18, 37. https://doi.org/10.3390/hematolrep18030037.
- Polese, F.; Pesce, C.; De Fusco, G.; Tidore, G.; Coluccia, E.; Battista, R.; Gessoni, G. Fetal Safety of Intravenous Ferric Carboxymaltose in Pregnancy: A Cardiotocography Study from a Tertiary Care Hospital in Italy. Hematol. Rep. 2026, 18, 7. https://doi.org/10.3390/hematolrep18010007.
- Alexiadou, S.; Tsouvala, E.; Mantadakis, E. Pediatric Oral Iron Therapy: Choosing the Right Product for Your Patient. Hematol. Rep. 2026, 18, 20. https://doi.org/10.3390/hematolrep18020020.
- Leone, G.; Arrabito, M.; Russo, G.; La Spina, M. Iron Therapy in Pediatric Iron Deficiency and Iron-Deficiency Anemia: Efficacy, Safety, and Formulation-Specific Trade-Offs—A Narrative Review. Hematol. Rep. 2026, 18, 6. https://doi.org/10.3390/hematolrep18010006.
- Chun, N.; Aman, S.; Xu, D.; Wang, J.; Zuppan, C.; Kheradpour, A. Anemia Due to Unexpected Zinc-Induced Copper Deficiency. Hematol. Rep. 2025, 17, 35. https://doi.org/10.3390/hematolrep17040035.
- Angastiniotis, M.; Eleftheriou, A. Haematologists as Genetic Counsellors for Haemoglobinopathies: Are They Prepared?. Hematol. Rep. 2025, 17, 48. https://doi.org/10.3390/hematolrep17050048.
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