Distinction between Hb S beta-thalassemia and sickle cell anemia is not always possible on clinical, hematologic, or electrophoretic grounds. Thalassemia heterozygotes have hypochromia and microcytosis, but overlap values exist. Differentiation can best be made by family or molecular pathology methods. Regional prevalence in the midwest area of Hb S beta-thalassemia is estimated to be 1:23,000 of the black population. It is recommended that positive sickle cell patients be further evaluated with Hb fractionation (HPLC), Hb F studies, and family studies. Complete characterization may require sophisticated laboratory studies with DNA amplification.