To the Editor.
—A young man, 21 years of age, was diagnosed as having pure red blood cell aplasia at the University of New Mexico, Albuquerque, and at the University of Arizona, Tucson, in 1974 and 1983, respectively.The patient had been treated with prednisone therapy (80 mg/d) with intermittent blood transfusions. From September 1983 to January 1984, it was noted that despite prednisone therapy he required blood transfusions every ten to 15 days to maintain a hematocrit value of 25% (0.25).Over the years, he has developed multiple antibodies due to multiple blood transfusions. As a result of longterm therapy with corticosteroids, the patient has bilateral avascular necrosis of the femoral heads; hence, increasing the corticosteroid dose was not appropriate. A splenectomy was performed to increase the useful life of transfused red blood cells, even though the patient's spleen was not enlarged. As an incidental finding, it was noted