The a-globin gene is duplicated on each copy of chromosome 16, so there are a total of four a-globin
genes (two genes per haploid; a1 and a2) in a normal genotype (aa/aa) (Fig. 2). They appear to have a
higher tendency for deletions than most of the mutations affecting the b-globin gene, which frequently
result from one or more nucleotide substitution or deletions. The production of a-globin decreases in
proportion to the number of genes deleted[9,10]. The clinical severity of a-thalassemia relates to the
number of genes affected out of the four a genes and correlates with the presence of the g4 or b4
tetramers, and the extent to which they reduce erythropoiesis and red cell survival[11]. Recently, a
correlation between a/b-globin mRNA ratio and disease severity was shown[12](Table 1). The most
serious and frequently fatal of the a-thalassemia syndromes is that of the four gene–deletion syndrome,
hydrops fetalis[13]. Deletion of three a genes, resulting in hemoglobin H (Hb H) disease, has a mild to
moderately severe phenotype, while deletion of two or one a-globin genes has no clinical significance