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Features include: Heinz bodies, Heinz body anemia, and Nonspherocytic hemolytic anemia.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Blood and immune system | 2 | Heinz body anemia, Nonspherocytic hemolytic anemia |
HBA1 encodes hemoglobin subunit alpha 1 (142 aa). Involved in oxygen transport from the lung to the various peripheral tissues Highest expression in Whole Blood (15,499 TPM) and Spleen (90.4 TPM).
Heinz body anemia is associated with mutations in the HBA1 gene on chromosome 16.
HBA1 is classified as a druggable target with score 8.7.
HBA2 encodes hemoglobin subunit alpha 2 (142 aa). Involved in oxygen transport from the lung to the various peripheral tissues Highest expression in Whole Blood (80,864 TPM) and Spleen (944.8 TPM).
Heinz body anemia is associated with mutations in the HBA2 gene on chromosome 16.
HBA2 is classified as a druggable target with score 8.7.
HBB encodes hemoglobin subunit beta (147 aa). Involved in oxygen transport from the lung to the various peripheral tissues Highest expression in Whole Blood (267,405 TPM) and Spleen (3,152 TPM).
Alpha-thalassemia (-thalassemia) has two clinically significant forms: hemoglobin Bart hydrops fetalis (Hb bart) syndrome (deletion/inactivation of all four alpha globin [-globin] alleles;--/--), and hemoglobin H (HbH) disease (most frequently caused by deletion/inactivation of three -globin alleles;--/-) . Hb Bart syndrome should be suspected in the following:
An at-risk fetus with increased nuchal thickness, thickened placenta, increased cerebral media artery velocity, and increased cardiothoracic ratio on ultrasonography examination at 13-14 weeks' gestation
No approved treatments are currently available for Heinz body anemia. The disease remains an area of unmet medical need.
In 2017, the Thalassemia International Federation updated its Guidelines for the Management of Non-Transfusion-Dependent Thalassemia, including beta-thalassemia (-thalassemia) intermedia, HbH disease, and hemoglobin E/-thalassemia .
To establish the extent of disease and needs in an individual diagnosed with alpha-thalassemia (-thalassemia), the evaluations summarized in this section (if not performed as part of the evaluation that led to the diagnosis) are recommended. Hemoglobin Bart hydrops fetalis (Hb Bart) syndrome. See .
HbH disease
Hematologic evaluation every six to 12 months to determine the steady state levels of Hb
In children, assessment of growth and development every six to 12 months
Monitoring of iron load with annual determination of serum ferritin concentration in individuals who have been transfused, in older individuals, and in those given inappropriate iron supplementation. Since serum ferritin may underestimate the degree of iron overload, a periodic noninvasive quantitative measurement of liver iron concentration by MRI is also recommended .
No clinical trials have been registered for Heinz body anemia.
7 publications have been identified in PubMed for Heinz body anemia. Research spans Case Report / Case Series (43%), Diagnostic / Biomarker (14%), and Review / Meta-Analysis (14%).
Raviola M (2026). [PMID: 42091220](https://pubmed.ncbi.nlm.nih.gov/42091220/). *Hemoglobin*. [Case Report / Case Series]
Krutish A (2025). [PMID: 40458561](https://pubmed.ncbi.nlm.nih.gov/40458561/). *Frontiers in genetics*. [Case Report / Case Series]
Zhang X (2025). [PMID: 40993672](https://pubmed.ncbi.nlm.nih.gov/40993672/). *Journal of translational medicine*. [Epidemiology / Natural History]
Žoldáková M (2025). [PMID: 39860253](https://pubmed.ncbi.nlm.nih.gov/39860253/). *Molecules (Basel, Switzerland)*. [Review / Meta-Analysis]
Panyasai S (2025). [PMID: 39956031](https://pubmed.ncbi.nlm.nih.gov/39956031/). *Hematology, transfusion and cell therapy*. [Basic Science / Preclinical]
Data assembled from 7 of 12 sources · Last updated Sep 20, 2026, 3:18 PM UTC
Online Mendelian Inheritance in Man
European rare disease database
Common questions about Heinz body anemia
The clinically significant phenotypes of alpha-thalassemia (-thalassemia) are hemoglobin Bart hydrops fetalis (Hb Bart) syndrome and hemoglobin H (HbH) disease. The severity of the -thalassemia syndromes depends on the extent of the alpha globin (-globin) chain defect . Hb Bart syndrome is the most severe clinical condition related to -thalassemia. Affected fetuses are either delivered stillborn at 30-40 weeks' gestation or die soon after birth. The main clinical features are generalized edema and pleural and pericardial effusions as a result of congestive heart failure induced by severe anemia. Notably, red cells with Hb Bart have an extremely high oxygen affinity and are incapable of effective oxygen delivery.
Source: GeneReviews — "Alpha-Thalassemia"
Heinz body anemia is associated with mutations in the HBB gene on chromosome 11.
HBB is classified as a druggable target (Druggable Genome and Enzyme categories) with score 1.8.
The phenotype of the -thalassemia syndromes depends on the degree of -globin chain deficiency relative to beta globin chain production. The correlation between -thalassemia pathogenic variants, -globin mRNA levels, -globin synthesis, and clinical manifestations of -thalassemia is well documented.
Hb Bart syndrome
Most often caused by large deletions on both chromosomes (--/--)
Rarely, an individual with Hb Bart syndrome will have a non-deletion variant (--/ND-).
HbH disease
Source: GeneReviews — "Alpha-Thalassemia"
A fetus with generalized edema, ascites, and pleural and pericardial effusions on ultrasonography examination at 22-28 weeks' gestation
Source: GeneReviews — "Alpha-Thalassemia"
Hydrops fetalis is associated with many conditions in addition to Hb Bart, including immune-related disorders (e.g., alloimmune hemolytic disease, Rh isoimmunization), fetal cardiac anomalies, chromosome abnormalities, fetal infections, genetic disorders, and maternal and placental disorders. The combination of a hydropic fetus with a very high proportion of Hb Bart, however, is found in no other condition.
Hemolytic anemias. HbH disease can be distinguished from other hemolytic anemias by: (1) microcytosis, which is uncommon in other forms of hemolytic anemia; (2) the fast-moving band (HbH) on hemoglobin electrophoresis; (3) the presence of inclusion bodies (precipitated HbH) in red blood cells after supravital stain; and (4) absence of morphologic ...
Source: GeneReviews — "Alpha-Thalassemia"
Genetic testing for HBA1, HBA2, HBB is available. Testing is considered confirmatory for diagnosis.
Biomarker and diagnostic research for Heinz body anemia has been reported in the published literature.
Hemoglobin H (HbH) disease
Differentiation of deletion (mild) from non-deletion (moderate to severe) forms of HbH disease by appropriate molecular genetic testing of HBA1 and HBA2 at presentation because of varying severity
Referral to a hematologist
Consultation with a medical geneticist, certified genetic counselor, or certified advanced genetic nurse to inform affected individuals and their families about the nature, mode of inheritance, and implications of -thalassemia in order to facilitate medical and personal decision making
Hb Bart syndrome was previously considered a universally fatal condition; however, its prognosis is shifting because of prenatal testing, intrauterine blood transfusions, improved transfusion strategies, and (rarely) curative hematopoietic stem cell transplantation .
Source: GeneReviews — "Alpha-Thalassemia"
HbH disease. Avoid the following:
Inappropriate iron therapy
Oxidant drugs according to recommendations for G6PD deficiency (full text; note especially Table 1. Drugs To Be Avoided by G6PD-Deficient Patients, and Table 2. Drugs To Be Used With Caution in Therapeutic Doses for Patients With G6PD Deficiency).
Source: GeneReviews — "Alpha-Thalassemia"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Alpha-Thalassemia"
View trials for Heinz body anemia
Source: GeneReviews — "Alpha-Thalassemia"
DeGroat W (2024). [PMID: 39489837](https://pubmed.ncbi.nlm.nih.gov/39489837/). *Scientific reports*. [Diagnostic / Biomarker]