Hi Raf and welcome,
First thing I want to say is that your spleen is dangerously enlarged. 25 cm is huge! If you read any posts I have made on this subject, you will see that I am normally very slow to recommend a splenectomy for anyone. Once it's removed, it's a final decision so I always say go slowly in making this decision. But when it's as big as yours, I doubt there's much choice. Your spleen is no longer functioning as it should and is destroying your red blood cells at a rapid rate, and this is why your Hb has dropped and your spleen has swollen to such a large size. It is the red cells that have been filtered out of your blood that are causing this and I fear you are past the point where one can hope for it to reverse itself. Your doctor will tell you if you are at a stage when it is imperative to remove the spleen.
1) The benefit from removing the spleen is that it may result in an increase in Hb. Sometimes this will be a long term change but sometimes it is only short term and your Hb will drop again. There is currently no way to predict the outcome. However, I feel you will get some benefit because your spleen is out of control and removing it, should make your red blood cells last longer.
2) Without the spleen prematurely filtering out RBC's, you should see an increase in Hb. I think because you have a history of having a higher Hb, that it is likely you will return to that level, at least for awhile, which will give you the chance to work at keeping your Hb up with some supplements, such as wheatgrass and resveratrol.
3) Talk to your doctor about the possibility of trying the drug, Hydroxyurea, which is used to raise hemoglobin levels. It is effective in many patients, but not all.
4) Red grapes include a substance called resveratrol which also does raise Hb in some people. Eating grapes is not an efficient way to get resveratrol, but they are a good source and can be used. If you want to try this, get the supplement, resveratrol from a vitamin company. I would suggest using wheatgrass tablets or extract along with it, as they both can be of help.
5) There is no way to know if you will eventually need transfusions. I think you should try alternatives first, such as splenectomy and using hemoglobin inducers as mentioned above. You have a history of a relatively high Hb so you may be able to escape transfusions.
6) Very few doctors will recommend a bone marrow transplant for a non-transfusing patient because of the risks involved with BMT.
7) The outcome for intermedia varies but many patients do require transfusions as they get older. Once again, you have a history of a higher Hb so you may be able to avoid transfusions completely.
Hydroxyurea is often being used with recombinant human erythropoietin (EPO) to add to the increase in fetal hemoglobin. I have also posted at
http://www.thalassemiapatientsandfriends.com/index.php?topic=1685.msg13954#msg13954 about a recent study that examined the effects of certain homeopathic remedies that when added to hydroxyurea increase the amount of HbF being produced. This study also found that many patients using that combination also had a reduction in spleen size. Hydroxyurea might have some positive effect on your spleen size but I don't know if your doctor might be willing to try that before splenectomy to see if you can get some reduction in spleen size. I should point out that splenectomy has in recent years been implicated as a factor in increased pulmonary hypertension (high blood pressure in the arteries that feed the lungs) in thalassemics, and it is long known that splenectomy weakens the immune system, so splenectomy also has some negative results.
If your doctor determines that you are in danger because of your spleen size, he will insist that it be removed. If he is willing to try, you could see if hydroxyurea might help decrease it's size while raising your Hb.
I should also point out that your iron levels should be checked as the large spleen indicates a high amount of bone marrow activity to produce the red blood cells being destroyed, so it is likely you will have excess iron being absorbed from your foods. Drink tea with your meals to help prevent this and have your ferritin checked. I also think you may benefit from taking some other supplements like vitamin E. See the thread at
http://www.thalassemiapatientsandfriends.com/index.php?topic=118.0;highlight=vitamin+mineralThalassemics are under tremendous physical stresses that deplete many vitamins and minerals and much higher doses are often required for thals than non-thals. Folic acid and vitamin E are two in particular.