When non-Whiteness becomes a condition

Merz, Lauren E.; Achebe, Maureen

doi:10.1182/blood.2020008600

Cited by 47 publications

(58 citation statements)

References 28 publications

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“…The findings of this study are consistent with those of Gari et al [10] who also reported a high prevalence (20%) of neutropenia in Jeddah. Several other studies have shown a variable frequency of neutropenia among different populations [9,[13][14][15]. Moreover, the findings of this study indicated that the 2.5 th percentile of neutrophil count was lower than what is accepted now as lower end of the reference range;1.5 × 10 9 /L, in all seven cities.…”

Section: Discussionsupporting

confidence: 41%

Isolated Neutropenia/Benign Ethnic Neutropenia: A Common Clinical and Laboratory Finding in Southern and Southwestern Saudi Arabia

Awan¹,

Amoudi²,

Saboor³

et al. 2020

Preprint

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Objectives: Isolated mild neutropenia is a common clinical problem. The current study aims to validate our previous findings regarding the high prevalence of isolated neutropenia in Southern and Southwestern Saudi Arabia and explore the effect of altitude or regional differences. Methods: In this retrospective cross-sectional study, laboratory results of a commercial laboratory were screened over a period of 5 years (2016–2020) in seven different cities in South and southwestern Saudi Arabia. Participants’ laboratory investigations were reviewed and excluded for any ab-normal complete blood count, renal profile, liver profile, lipid profile, thyroid function test, fasting blood glucose, or HbA1c findings. Descriptive analysis and 95th percentile range were calculated using standard statistical methods. Results: A total of 91,880 complete blood count results were included in the final analysis. isolated neutropenia is common laboratory finding, with a prevalence ranging from 11-23%. The 2.5th percentile of the neutrophil count was lower than 1.5×109/L in all seven cities. Conclusions: Mild to moderate neutropenia is common in Southern and Southwestern Saudi Arabia. Benign ethnic neutropenia (BEN) may explain this high prevalence. Since BEN has no clinical significance, the reference range for normal neutrophil counts needs to be adjusted to reflect the effect of BEN.

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Section: Discussionsupporting

confidence: 41%

Isolated Neutropenia/Benign Ethnic Neutropenia: A Common Clinical and Laboratory Finding in Southern and Southwestern Saudi Arabia

Awan¹,

Amoudi²,

Saboor³

et al. 2020

Preprint

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“…44 colonial-era slave trade has resulted in a majority of African Americans carrying the Duffy-null variant. This ancestryinformative marker has been identified as the cause of the clinically inconsequential pattern of benign ethnic neutropenia, [63][64][65] which causes African Americans to have a lower average circulating white blood cell count compared with White Americans. It has also been proposed that Duffy-null status be considered in monitoring blood counts in patients with breast cancer receiving treatments associated with neutropenia.…”

mentioning

confidence: 99%

Disparities in Breast Cancer Associated With African American Identity

Stringer-Reasor

Elkhanany

Khoury

et al. 2021

American Society of Clinical Oncology Educational Book

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Persistent disparities in the burden of breast cancer between African Americans and White Americans have been documented over many decades. Features characterizing breast cancer in the African American community include a 40% higher mortality rate, younger age distribution, greater advanced-stage distribution, increased risk of biologically aggressive disease such as the triple-negative phenotype, and increased incidence of male breast cancer. Public health experts, genetics researchers, clinical trialists, multidisciplinary oncology teams, and advocates must collaborate to comprehensively address the multifactorial etiology of and remedies for breast cancer disparities. Efforts to achieve breast health equity through improved access to affordable, high-quality care are especially imperative in the context of the COVID-19 pandemic and its disproportionately high economic toll on African Americans.

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“…As recently demonstrated by Merz and colleagues, the number of neutrophils in individuals with BEN is perfectly adequate for host defence, so it should be considered a normal variant and not a "condition" or "disease" [23]. Duffy antigen phenotyping or ACKR1 gene sequencing is considered gold standard for identifying BEN, but this procedure is not currently performed in either of the study sites.…”

Section: Determining Ben In the Cnrd Cohortmentioning

confidence: 99%

“…Nevertheless, our method is consistent with existing literature and may possibly even enhance our findings if BEN prevalence is higher when patients from a wider demographic are included. Ideally, future studies should look at pharmacogenetic testing to identify the ACKR1 genotype (rs2814778 C-C allele SNP) opposed to selfdeclared ethnicity when screening for BEN [3,23,45,46] especially considering that studies have demonstrated a weak correlation between skin colour or selfdeclared race and genetic ancestry [47]. While diagnostic agreement between haematologists was very good in our study, the investigational emphasis relies on excluding other putative causes for neutropenia, and entails timeconsuming, laborious and expensive tests, to make a diagnosis of exclusion, for essentially a non-pathogenic ethnic variation in normality.…”

Section: Limitations and Future Studiesmentioning

confidence: 99%

“…While a growing body of literature exists on the pathophysiology of BEN [45,50,51], authors have noted that ANC reference ranges in many countries are not representative of the entire population [23] and some have suggested the need for ethnic-specific reference ranges for haematological values to reduce racial disparities in patient outcomes [52,53]. However, this is further complicated by reports of more than one reference range for haematological values in a single ethnic or racial group [54,55].…”

Section: Limitations and Future Studiesmentioning

confidence: 99%

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Benign ethnic neutropenia: an analysis of prevalence, timing and identification accuracy in two large inner-city NHS hospitals

et al. 2021

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Background Benign ethnic neutropenia (BEN) is the most common cause of chronic neutropenia seen in individuals of African, Middle Eastern and West Indian descent. This phenotype is broadly defined by an absolute neutrophil counts (ANC) below 1.8 × 109 cells/L in the absence of other causes, without an increased risk of infection. BEN has been implicated as a potential source of disparity in patients treated with clozapine, the antipsychotic of choice in treatment-resistant schizophrenia. Our main objective was to examine the current level of BEN recognition in a cohort of patients treated with clozapine and the potential impact of unidentified BEN on the initiation and maintenance of clozapine treatment. Methods This was an observational, retrospective analysis of patients registered with clozapine haematological monitoring systems in two large mental health trusts, chosen because they serve an ethnically diverse population. The first objective was to establish certified BEN prevalence in current users of clozapine. The second objective was to explore the stage of treatment at which BEN was identified. The third objective was to evaluate the extent of unrecognised BEN in patients registered on the Central Non-Rechallenge Database (CNRD), a database for patients whose haematological parameters fall below set thresholds when receiving clozapine treatment, meaning they cannot ordinarily be prescribed clozapine again. Results The study population comprised of 2020 patients on the clozapine register. 111 patients were monitored under BEN criteria. BEN was mostly identified after a below threshold haematological result or clozapine rechallenge (68%) compared to at clozapine initiation (32%). Eight of the 18 (42%) black patients registered on the CNRD were classified as BEN after assessment by a haematologist. Of these 8 patients, none would have met CNRD criteria again if monitored with BEN criteria at clozapine initiation. Conclusions Current evidence suggests that BEN remains an uncommonly recognised haematological phenotype. Improved timely identification of BEN will reduce unnecessary interruption or discontinuation of clozapine treatment. Our results suggest consideration should also be given to determining BEN status prior to initiating clozapine. Moreover, adoption of current FDA BEN monitoring criteria in the UK may further reduce clozapine discontinuation due to perceived neutropenia as drug toxicity, particularly in treatment-refractory schizophrenia patients.

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When non-Whiteness becomes a condition

Cited by 47 publications

References 28 publications

Isolated Neutropenia/Benign Ethnic Neutropenia: A Common Clinical and Laboratory Finding in Southern and Southwestern Saudi Arabia

Isolated Neutropenia/Benign Ethnic Neutropenia: A Common Clinical and Laboratory Finding in Southern and Southwestern Saudi Arabia

Disparities in Breast Cancer Associated With African American Identity

Benign ethnic neutropenia: an analysis of prevalence, timing and identification accuracy in two large inner-city NHS hospitals

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