Haemoglobin Bart's hydrops fetalis syndrome (BHFS) represents the most severe form of α-thalassaemia, arising from deletion of the duplicated α-globin genes from both alleles. The absence of α-globin leads to the formation of non-functional haemoglobin Bart's (γ4) or haemoglobin H (HbH: β4) resulting in severe anaemia, tissue hypoxia, and, in some cases, variable congenital or neurocognitive abnormalities. BHFS is the most common cause of hydrops fetalis in Southeast Asia; however, owing to global migration, the burden of this condition is increasing worldwide. With the availability of intensive perinatal care and intrauterine transfusions, an increasing number of patients survive with this condition. The current approach to long-term management of survivors involves regular blood transfusions and iron chelation, a task made challenging by the need for intensified transfusions to suppress the production of non-functional HbH-containing erythrocytes. While our knowledge of outcomes of this condition is evolving, it seems, in comparison to individuals with transfusion-dependent β-thalassaemia, those with BHFS may face an elevated risk of complications arising from chronic anaemia and hypoxia, ongoing haemolysis, iron overload, and from their respective treatments. Although stem cell transplantation remains a viable option for a select few, it is not without potential side effects. Looking ahead, potential advancements in the form of genetic engineering and innovative therapeutic approaches, such as the reactivation of embryonic α-like globin gene expression, hold promise for furthering the treatment of this condition. Prevention remains a crucial aspect of care, particularly in areas with high prevalence or limited resources.
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Research Article|
March 8, 2024
Haemoglobin Bart's Hydrops Fetalis: Charting the Past and Envisioning the Future
Ali Amid,
BC Children's Hospital, Vancouver, British Columbia, Canada
* Corresponding Author; email: ali.amid@cw.bc.ca
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Siyu Liu,
Siyu Liu
MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
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Christian Babbs,
Christian Babbs
University of Oxford, Oxford, United Kingdom
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Douglas R Higgs
Douglas R Higgs
MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
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Blood blood.2023023692.
Article history
Submitted:
December 21, 2023
Revision Received:
February 14, 2024
Accepted:
February 29, 2024
Citation
Ali Amid, Siyu Liu, Christian Babbs, Douglas R Higgs; Haemoglobin Bart's Hydrops Fetalis: Charting the Past and Envisioning the Future. Blood 2024; blood.2023023692. doi: https://doi.org/10.1182/blood.2023023692
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