Anaemia remains the most prevalent nutritional disorder among children in the Middle East and North Africa region. Between 2000 and 2005, the prevalence of anemia increased from 37.04% to over 52% among Egyptian children 
between 12 months and 36 months of age. Children under the age of 24 months who had recently been sick and those who resided in Upper Egypt were significantly more likely to be anaemic. (Austin et al., 2012 )The major problem in anemia is insufficient oxygen supply to meet the requirement for tissue oxygenation. Systemic oxygen delivery depends on cardiac output and arterial oxygen content. Although anemic infants have increased cardiac output, echocardiographic measurements are not very useful for determining the need for transfusion. Because arterial oxygen content is determined by the amount and type of hemoglobin, most RBC transfusion guidelines are based on hemoglobin threshold levels. However, hemoglobin is a poor predictor for oxygen delivery (Alkalay et al., 2003).
Because direct measurement of tissue oxygenation is not possible, various surrogate markers have been suggested. The reliability of clinical parameters such as tachycardia or poor weight gain has been questioned. Although measurement of fractional oxygen extraction by using near-infrared spectroscopy may be promising, a pilot study failed to identify infants who required RBC transfusion, and although serum lactate was considered predictive, values show great variability and 
added little information to the decision regarding whether to transfuse. Thus, there currently is not a reliable method for assessing tissue oxygenation (Frey and Losa, 2001).  Vascular endothelial growth factor (VEGF) is known also as vascular permeability factor, is characterized by its highly specific mutagenic activity for endothelial cells and by its angiogenic effect observed in vitro and vivo (Ferrara and Gerber, 2002).