Hb Constant Spring (Hb CS; alpha142, Term-->Gln, TAA-->CAA in alpha2) is the most prevalent nondeletional alpha-thalassemia (thal) in Southeast Asian populations. It is difficult to detect on electrophoresis in its heterozygous state because of the low Hb CS levels. We found a case with Hb H (beta4) disease who, at birth, was initially assumed to have deletional alpha-thal mutations, but eventually proved to have a Hb CS defect.