Therefore, regardless of the distribution of the six α-globin genes, whether homozygous triplication (ααα/ααα) or heterozygous quadruplication (αααα/αα), the association with heterozygous β-thalassemia resulted in severe to moderate anemia that might require transfusion therapy, with the severity of the HBB gene mutation determining the clinical variation, as noted by Traeger-Synodinos et al. (15) and Sollano et al. (16). The gene discussed is HBB; the disease is anemia (phenotype).