Prenatal diagnosis and management of fetal anemia caused by hemoglobin H-Adana: A case report

Abstract

Hemoglobin (Hb) Adana, the alpha-globin gene mutation at codon 59 (GGC → GAC), is very rare globally but occasionally encountered in Southeast Asia. Its combination with alpha0-thalassemia (–^SEA) results in Hb H-Adana, which can lead to severe fetal anemia. This report describes a 22-year-old woman at 33 weeks, presenting with fetal cardiomegaly with early hydropic changes and anemia (middle cerebral artery peak systolic velocity: 1.75 multiple of median [MoM]). Cordocentesis revealed a Hb level of 4.3 g/dL, and intrauterine transfusion (IUT) was performed. However, non-reassuring fetal heart rate developed after IUT and cesarean section was performed. A preterm live male infant was delivered, weighing 1455 g, and was confirmed to be Hb H-Adana. Post-natal life was transfusion-dependent. In conclusion, this case focuses on prenatal features of fetal Hb H-Adana, which caused fetal anemia and hydrops fetalis in the third trimester. In cases of unexplained fetal anemia, Hb H-Adana should be listed in the differential diagnoses, especially in areas of high prevalence.