Hi Babynorth,
I think it's still too early to say if her Hb will stay as high as it is now. Intermedias often do not show much evidence of thalassemia until two years old, and the condition may continue to worsen over the next several years. However, your child's Hb has been fairly stable and she is doing well. In addition, her hemoglobin level is about 90% HbF, which shows a strong ability to produce fetal hemoglobin, not because it is 90%, but because that 90% = an HbF of 7+ on its own. This could prove to be very beneficial, as there are both natural methods and drugs that can stimulate the production of HbF, thereby keeping the patient transfusion free. Wheatgrass shots and resveratrol are two natural substances that have helped raise the HbF in some patients. The drug, hydroxyurea is also commonly used to raise the HbF, but the drug route won't usually be used until the Hb drops into the 6-7 range. The wheatgrass shots made by Dr Wheatgrass (Dr Chris Reynolds) are very easy for children to take. And of course, the good diet will also help. In addition to minimizing red meat, avoid citrus with meals, as vitamin C aids in the absorption of iron, Drinking tea with meals will help prevent iron from being absorbed from plant foods. Minimizing iron absorption is an important matter in those with chronically low Hb levels, as the body will absorb too much iron when the Hb is low in an attempt to build more red blood cells, but this means it builds many bad red blood cells that are of no use to the body and also cause other problems like clotting issues. It is better to try to stimulate the production of red blood cells containing fetal hemoglobin, as these will be normal, useful RBC's.
The approach to treatment of thalassemia intermedia has changed greatly in the past 10 years, with more emphasis being placed on transfusing so that normal growth and development occur. This should be the main criteria for determining if transfusion does become necessary. If the growth and development are noticeably slowed, transfusions will most likely be recommended. In the past, transfusions were avoided at all costs, but with the variety of iron chelating drugs available and the development of managed care, the focus has shifted from avoiding transfusions to an emphasis on the quality of life that can be had with a higher hemoglobin level. This is a decision that you may eventually have to make but right now things look good.
Looking to the future, one very interesting area of research has been into new drugs to stimulate fetal hemoglobin production. Stage two trials are currently being conducted. Funding is an ongoing issue, as it is for many areas of thalassemia research, but we should expect to see new drugs within the next ten years. This could totally eliminate any need for transfusions in thal intermedias.