ABSTRACT: BACKGROUND:Low HbA2 level is an underlying of ?-thalassemia, ?-thalassemia, and IDA. Interactions of these disorders can generate a wide spectrum of phenotype, which will pose diagnostic conundrum for clinical assessment, carrier screening, and genetic counseling. METHODS:Subjects with HbA2 levels below 2.0% with normal or reduced hematological parameters were recruited for further investigation. ?-globin gene mutations were identified by DNA sequencing of the HBD gene. Serum ferritin (SF) concentration was determined by the chemiluminescent microparticle immunoassay. The three common deletional ?-thalassemia (--SEA /??, -?3.7 /??, and -?4.2 /??) were detected using Gap-PCR, detection of the point mutations in the three nondeletional ?-thalassemia (?CS ?/??,?QS ?/??,?WS ?/??), and the 17 common ?-thalassemia was performed using reverse dot blot hybridization (RDB). RESULTS:We had characterized the ?-globin gene mutations in 20 cases, revealing a frequency of 0.4% in the women of reproductive age (20/4 792). Two previously known mutations:-77 T > C and -30 T > C and 3 novel ?-globin gene defects: -44G > A,CD87C > T, and CD134T > A were found. In the selected cases, we also found 85 cases confirmed with (51.2%,85/166) IDA and 39 cases (23.5%,39/166) with common ?-thalassemia. Subjects with ?-thalassemia had statistically higher levels of Hb, MCV, and MCH compared with other two groups, whereas statistically lower levels of RDW were seen in ?-thalassemia group. What's more, statistically higher levels of SF were seen in ?-thalassemia group, compared with IDA groups. CONCLUSION:We reported the spectrum of ?-thalassemia mutations for the first time with the frequency of 0.4% among women of reproductive age in Fujian area and found that -77T > C mutation was the most common mutation, followed by -30T > C mutation. What's more, 3 novel ?-globin gene defects: -44G > A,CD87C > T and CD134T > A were found. A thorough analysis of the hematological, electrophoretic characterization, and the level of SF was needed to suspect and further investigate the existence of IDA, ?-thalassemia, and ?-thalassemia.