Hi mamaammar,
It sounds like Ammar is thal intermedia. If he was a major, he would be transfusing at a much younger age. The supplements are all good but make sure the dose of vitamin C isn't more than 100 mg daily at this age, because it does help to increase the amount of iron he absorbs from foods, and this should be avoided. I would suggest 100 IU natural vitamin E also. If his Hb doesn't improve, you will be faced with two options. One is transfusion. The way you describe him, I am concerned that his growth and development will be affected by his low hemoglobin level. He needs a higher Hb than he has now. The other option is to try hydroxyurea to see if this can boost his Hb enough to avoid transfusions. Talk to your doctor about this possibility. Even though it involves the use of a drug, I feel it should be explored before transfusing because transfusions should always be a final choice. His hemoglobin level can't be allowed to continue to drop, so some action will have to be taken soon. Once the child is pale and loses energy, there is really no choice. It is a critical age for growth and you don't want it stunted by lack of blood. I would recommend hydroxyurea if possible. There is a new drug that will be approved in the coming years that works better than hydroxyurea and should have fewer side effects, too. Once this drug is approved, it will make it much easier for intermedia thals, as it will raise Hb up to thal minor level in intermedias. Let us know if you do choose the hydroxyurea option, because there are two more supplements to add once that starts. I would also suggest continuing the supplements he is now taking, as long as he tolerates them well.