Hi Cheryl,
First, I want to make sure you are aware that there are various foods, medications and chemicals that can add to the hemolysis of alpha thal and that these should be avoided so that a hemolytic crisis doesn't take place, as this reduces the Hb and causes enlargement of the spleen and gallstones due to the breakdown of red blood cells (RBC's). Foods to avoid begin with fava beans, but some patients report problems with other beans and legumes, so observation is necessary when consuming anything from this group. You can see a list of some of the drugs and chemicals to avoid with alpha thal at
http://www.thalassemiapatientsandfriends.com/index.php/topic,3410.msg34830.html#msg34830Avoid exposure to any chemicals that give off fumes like gasoline or moth balls.
Is the child taking daily folic acid? This is a must for all alpha thals. 1 mg minimum daily would be appropriate at this age.
I am always hesitant to agree with surgery unless a real danger is present. If there is a danger of gallbladder rupture, then removal could be necessitated. If there is no immediate danger, then it may not be urgent. An approach using folic acid, antioxidants and a diet high in antioxidants, along with avoiding the above mentioned items, might work to relieve some of the problem by slowing the hemolysis that will always take place with HbH. With Constant Spring, transfusions may occasionally be required.
What is the rationale for the liver biopsy? Is there something that can be learned that wouldn't be shown by a non-invasive MRI? Where is the child being treated and is the treatment under the supervision of one of the US centers of Excellence?