PMCH and anemia (phenotype): Lykavieris et al. investigated autoimmune liver disease in children with SCD and highlighted the impact of chronic hemolytic anemia on liver function, which can be indirectly associated with variations in MCH levels due to the chronic hemolysis characteristic of SCD [29]. Dougherty et al. examined muscle strength and power deficits in children with type SS SCD and found that lower MCH values were often associated with more severe anemia and related complications, suggesting the importance of monitoring MCH in these patients [30].