Assessment of Erythrocyte Indices in Children with Microcytic Hypochromic Anemia After Iron Treatment in Benghazi

Abstract

Microcytic hypochromic anemia represents a significant pediatric hematological concern, with iron deficiency anemia (IDA) being the predominant etiology. Assessment of erythrocyte indices provides valuable information regarding treatment response and hematological recovery. This study aimed to evaluate changes in erythrocyte indices following iron treatment in children with microcytic hypochromic anemia, including those with IDA, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and hemophilia, and to identify predictors of hemoglobin response. A retrospective cross-sectional study was conducted using data from the Hematology outpatient clinics at Benghazi Medical Center from January 2015 to December 2025. A total of 325 children younger than 16 years with microcytic hypochromic anemia were included. Erythrocyte indices were assessed before and after 4–5 months of oral iron therapy at 3–6 mg/kg/day. Statistical analyses included paired-samples t-tests, Kruskal–Wallis tests, mixed-design general linear models, and multiple linear regression. Significant improvements were observed in all erythrocyte indices following treatment. Hemoglobin increased from 9.35 ± 1.10 to 11.43 ± 0.61 g/dL (p < 0.001), MCV increased from 65.14 ± 5.86 to 82.64 ± 4.90 fL (p < 0.001), and RDW decreased from 16.31 ± 2.06% to 12.62 ± 1.62% (p < 0.001). No significant differences in the magnitude of hematological change were observed among diagnostic groups. Baseline hemoglobin was the strongest predictor of hemoglobin change (β = −0.863, p < 0.001), with the regression model explaining 76.7% of the variance. Iron therapy effectively improved erythrocyte indices across all diagnostic groups, with comparable treatment responses regardless of underlying etiology. Baseline hemoglobin concentration serves as the principal determinant of treatment response magnitude.