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16. In newborn screening program detection of Hb Barts in a range of 20-25% is suggestive of ?
 HbH disease
 Alpha thal silent carrier
 Alph thal trait
 Hb Barts hydrops fetalis
Answer =  HbH disease
HPLC at birth in alpha thal syndromes.
*Hb Bart’s hydrops fetalis syndrome: Hb Bart’s > 80%, a variable amount of Hb Portland and HbH present, No HbA
*HbH disease: HbH > 20% at birth
*α-thalassemia trait: Hb Bart’s in newborns 4-10% may be up to 20 %
*α-thalassemia silent carrier: Hb Bart’s in newborns is up to 2%