alpha-Thalassemia trait is common in Black Americans; the (-alpha) haplotype occurs in 30% of that population. However, hemoglobin H disease (genotype:- -/-alpha) is very uncommon due to the rarity of the (- -) haplotype. A subject with HbH-HbG Philadelphia (alpha 2(68)Asn----Lys) synthesized only alpha G and no alpha A. Digestion of DNA with BamHI produced a single 10-kilobase (kb) alpha-specific fragment. Her son had alpha-thalassemia trait, did not make HbG Philadelphia, and demonstrated 14- and 10-kb alpha fragments upon BamHI digestion. Since the 14-kb fragment could not have been inherited from the mother, the son apparently received from her a chromosome bearing a single nonfunctional (alpha T) gene. Therefore, the two genotypes are: mother (-alpha G/-alpha T), son (-alpha T/alpha alpha). A 16-kb BglII fragment, containing the gene of interest from the son, was cloned into the BamHI site of phage EMBL 3 followed by subcloning of a 1.5-kb PstI alpha-specific fragment into plasmid pBR322. The mutant alpha gene demonstrated a deletion of an AG dinucleotide from the tandem repeat normally occurring in the Glu-Arg codons 30 and 31 at the junction of the first exon with intervening sequence 1. The loss of two nucleotides leads to a reading frameshift and a totally novel amino acid coding sequence in the second exon from codons 31-54 followed by the appearance of a chain termination codon (TAA) at position 55. No complete globin chain can be produced from this gene. HbH disease in this Black family is thus due to the combination of gene deletion and a nonfunctional alpha gene.