Alpha-thalassaemia is a common inherited blood disorder; approximately 5% of the global population carry a defective alpha-thalassaemia gene.[16]Thalassaemia International Federation. Guidelines for the management of alpha-thalassaemia (2023). 2023 [internet publication].
https://thalassaemia.org.cy/publications/tif-publications/guidelines-for-the-management-of-%ce%b1-thalassaemia
[17]Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ. 2008 Jun;86(6):480-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647473/pdf/06-036673.pdf
http://www.ncbi.nlm.nih.gov/pubmed/18568278?tool=bestpractice.com
The worldwide distribution of inherited alpha-thalassaemia corresponds to areas of malaria exposure, suggesting a protective role for alpha-thalassaemia against the more severe manifestations of malaria.[18]Flint J, Hill AV, Bowden DK, et al. High frequencies of alpha-thalassaemia are the result of natural selection by malaria. Nature. 1986 Jun 19-25;321(6072):744-50.
http://www.ncbi.nlm.nih.gov/pubmed/3713863?tool=bestpractice.com
Alpha-thalassaemia is common in sub-Saharan Africa, the Mediterranean basin, the Middle East, South Asia, and Southeast Asia; different genetic sub-types have variable frequencies in each of these areas.[19]Association of Public Health Laboratories; Centers for Disease Control and Prevention. Hemoglobinopathies: current practices for screening, confirmation and follow-up. Dec 2015 [internet publication].
https://www.cdc.gov/ncbddd/sicklecell/documents/nbs_hemoglobinopathy-testing_122015.pdf
[20]Weatherall DJ. The definition and epidemiology of non-transfusion-dependent thalassemia. Blood Rev. 2012 Apr;26(suppl 1):S3-6.
http://www.ncbi.nlm.nih.gov/pubmed/22631040?tool=bestpractice.com
[21]Kattamis A, Kwiatkowski JL, Aydinok Y. Thalassaemia. Lancet. 2022 Jun 18;399(10343):2310-24.
http://www.ncbi.nlm.nih.gov/pubmed/35691301?tool=bestpractice.com
Alpha(0) variants, which can lead to haemoglobin H (Hb H) or alpha-thalassaemia major, are most common in Southeast Asia, southern China, and the Mediterranean; prevalence of carriers is 14% in northern Thailand and 5% to 8.8% in southern China.[11]Chui DH, Waye JS. Hydrops fetalis caused by alpha-thalassemia: an emerging health care problem. Blood. 1998 Apr 1;91(7):2213-22.
https://ashpublications.org/blood/article/91/7/2213/261092/Hydrops-Fetalis-Caused-by-Thalassemia-An-Emerging
http://www.ncbi.nlm.nih.gov/pubmed/9516118?tool=bestpractice.com
The non-deletional mutation Hb Constant Spring is one of the most common variants of alpha-thalassaemia in Southeast Asia and southern China.[22]Jomoui W, Fucharoen G, Sanchaisuriya K, et al. Hemoglobin Constant Spring among Southeast Asian populations: haplotypic heterogeneities and phylogenetic analysis. PLoS One. 2015;10(12):e0145230.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0145230
http://www.ncbi.nlm.nih.gov/pubmed/26683994?tool=bestpractice.com
The epidemiology of alpha-thalassaemia in the US reflects this global distribution pattern. The most common form of alpha(+) thalassaemia in the US is due to the -alpha(3.7) deletion, a single alpha-globin gene deletion, and is present in approximately 30% of African-Americans.[23]Beutler E, West C. Hematologic differences between African-Americans and whites: the roles of iron deficiency and alpha-thalassemia on hemoglobin levels and mean corpuscular volume. Blood. 2005 Jul 15;106(2):740-5.
https://ashpublications.org/blood/article/106/2/740/21345/Hematologic-differences-between-African-Americans
http://www.ncbi.nlm.nih.gov/pubmed/15790781?tool=bestpractice.com
However, even in the homozygous state this disorder will result only in a mild microcytic anaemia. The more serious clinical disorders of Hb H and alpha-thalassaemia major are more common in the western US, and have increased in prevalence due to increased Asian immigration.[8]Vichinsky EP, MacKlin EA, Waye JS, et al. Changes in the epidemiology of thalassemia in North America: a new minority disease. Pediatrics. 2005 Dec;116(6):e818-25.
http://www.ncbi.nlm.nih.gov/pubmed/16291734?tool=bestpractice.com