9 Moreover, ANC reference ranges for African adults are variably reported to be 1050 to 4080 cells/μL, 10 910 to 4720 cells/μL, 11 and 500 to 5400 cells/μL, 12 all below the conventional adult ANC reference range used in most countries outside of Africa. 6-8 Data from the National Health and Nutrition Examination Survey show that African-American individuals have a white blood cell count that is on average 700 cells/μL lower than that in White American subjects. Although these terms have different definitions, the biases in medicine and research toward people of non-European ancestry or non-White skin remain the same.īEN is most commonly observed in people of African ancestry, and it is well known that people of European background often have higher peripheral ANC levels than people of African ancestry. Nevertheless, medicine routinely categorizes people based on physical features such as skin tone, better defined as race, but the implications for ethnicity are similar. Ethnicity is the grouping of people based on national or cultural similarities, whereas race is the social grouping of people based on skin color that has no genetic basis. 4,5 Ethnicity and race are not synonymous, but there is often a significant overlap. 3 However, BEN has also been described in people of other ethnicities, including people of Arab, West Indian, Egyptian, and Jordanian descent. BEN is an inherited cause of an absolute neutrophil count (ANC) <1500 cells/μL with no clinical sequelae or increased risk of infection that is most often seen in people of sub-Saharan African descent. One example of non-whiteness being ascribed the label of a condition in hematology is the designation of benign ethnic neutropenia (BEN). Although our understanding of and access to genetics has improved significantly in the past decades, our reliance on race as a proxy for genetic markers has not changed, suggesting that medicine as a profession, a system, and an institution has yet to erase racist ideologies acquired from the past. Thus, race as a proxy for genetics is woefully inadequate. 2 In fact, there is often more genetic variation within people of the same self-identified race than between those of different races. On the contrary, it is now categorically clear that there is no genetic basis by which we can classify humans into discrete races, and race is simply a socially construed grouping of humans based on shared physical or social qualities. Many clinical algorithms include race-based corrections with the implicit assumption that those with non-White skin are inherently “other.” 1 Before sequencing of the human genome, it was argued that racial “differences” were likely based in genetic variations concentrated within certain communities. There is a long history in medicine of using healthy White men as the standard for normal, ascribing anything different as abnormal, other, or requiring adjustments. We believe that it is important to examine and rectify practices in hematology that contribute to systemic racism. This labeling implicitly indicates that common phenotypes in non-White populations are abnormal or wrong. Thus, the predominantly White American medical system has described this as a condition. Benign ethnic neutropenia is clinically insignificant, but the average ANC values differ from what are typically seen in those of European descent. The lower ANC levels are driven by the Duffy null phenotype, which is protective against malaria and seen in 80% to 100% of those of sub-Saharan African ancestry and <1% of those of European descent. In addition, ANC reference ranges from countries in Africa emphasize that ANC levels <1500 cells/μL are common and harmless. It is most commonly seen in those of African ancestry. The term “benign ethnic neutropenia” describes the phenotype of having an absolute neutrophil count (ANC) <1500 cells/μL with no increased risk of infection.
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