It's very simple. The classification of thal intermedia is what causes the confusion. If a splenectomy can mostly eliminate transfusions, the patient is a transfusing intermedia (that is a very vague category). Many patients are diagnosed as majors because they require transfusions, but unlike a major, if they did not transfuse, their Hb level would still be high enough to survive, although with rather bad health. A true major would die if transfusions were stopped. This is actually very common because once a patient takes regular transfusions, many doctors will classify that patient as major, even though technically, their genotype would show intermedia. While a major might see some reduction in transfusion requirement after a splenectomy, it would not eliminate this need, as it can for many intermedia patients.