Case 4 depiction. A newborn with α-thalassemia major (−^SEA/−^SEA) was initially transfused with a goal of maintaining total Hb of 9 to 10 g/dL in the pretransfusion period (case 4). This was associated with effective functional Hb (total Hb − sum of HbH and Hb Bart) between 6 and 7 g/dL. Transfusion regimen was modified (arrow) to maintain HbA 9 to 10 g/dL, which was achieved with total Hb of ∼11 g/dL in the pretransfusion blood sample.