It is not possible to provide medical advise without a comprehensive review of medical information. However I can make some general observations
1) Steroids are not used in CDA unless there is some other issue (like alloimmunization showing up as alloantibodies or autoantibodies). Just haemolysis is not a justification.
2) Splenectomy is useful in only CDA II. It is not at all useful in other CDAs. It is therefore important to establish the diagnosis before anything like this is done especially as there are risks associated with removing spleen (chiefly immediate risk of surgical procedure and a long term risk of infections as immunity is suppressed). Infection risk is a bigger problem in south east Asian countries when compared to west. The earlier the spleen is removed the bigger the risk of infection. It is for this reason that splenectomy only rarely (if at all) is performed under 5 years of age.
The defect in CDA II is that Red cells are not made as efficiently as they should be (ineffective erythropoiesis). However a bigger problem is that what is made, is rapidly broken down in spleen (haemolysis). Therefore removing spleen helps. In clinical practice about one gram or so Hb raise is seen after removal of spleen.
3) If his Hb is around 8 -8.5 I would be happy with this, as long as he is asymptomatic and growing well.
4) It is likely he will still need transfusions intermittently when having usually childhood infections etc (averaging 2-4 per year at 10-20 ml/ kg)
5) Although the iron will start creeping up after 10-20 transfusions rarely this is problem before the age of 3-5y even in regularly transfused children.
6) If this is CDA II then it really resembles hereditary spherocytosis more than thalassemia major. And this is a source of significant clinical confusion.
Finally if properly managed especially upto early teens, CDA II is compatible with a normal life span and more or less normal activity. Later in life, say late third decade, problems with iron overload are seen. These can been seen sooner in some cases (regular transfused, male, iron rich diets, poor chelation etc) .
I would be happy to communicate with your clinician if you think that would help. This is an ultra rare disorder (1-2 per 3-5 million cases) with really no experts around.
Momin Ahmed email@example.com