To the Editor:—
In the communicacation of Egdahl and associates (JAMA186:745 [Nov 23] 1963) it was suggested that splenectomy is a valuable procedure in patients who have sickle cell anemia, hypersplenism, and profound hemolysis. I have observed that patients with marked splenomegaly show the most severe anemia (Atti Giornata Studio [Roma]1:98, 1961) and that childhood cases have always proved to be fatal. I have never observed an adult with marked splenomegaly. Furthermore, it is my belief that the prognosis of patients without splenomegaly is better than that of patients with marked splenomegaly and also that the size of the spleen is of prognostic significance. Therefore, I conclude that splenectomy is indicated not only for hypersplenism and hemolysis in sickle cell anemia but also for marked to moderate splenomegaly without frank evidence of hypersplenism and hemolysis.