ASH Announces 24 Institutions Selected for Duffy Status Health Equity Project

Institutions across the United States will participate in a project to establish new blood reference ranges for Duffy status

(WASHINGTON, May 15, 2024) — The American Society of Hematology (ASH) announces that 24 health and hospital systems have been selected to participate in the Absolute Neutrophil Count (ANC) by Duffy Status Project, which will redefine pediatric and adult ANC reference ranges by Duffy status and address a critical health equity concern. The project is funded by the Doris Duke Foundation as part of its Racial Equity in Clinical Equations initiative.

The Duffy-null phenotype is commonly found among people with African and Middle Eastern genetic ancestry, affecting approximately two of three people in the United States with this ancestral background. People with the Duffy-null phenotype may have a lower ANC, or white blood cell counts, which is used to determine risk of infection. While those with Duffy-null Associated Neutrophil Count (DANC) are not at increased risk of infection, they are often labeled as having neutropenia, a low white blood cell count that can lead to unnecessary, expensive, painful, and invasive testing.

Currently, ANC ranges considered healthy are primarily based on data from individuals of European and Asian descent and do not account for Duffy status. The exclusion of ANC reference ranges that include the phenotype can perpetuate systemic racism and lead to delayed or discontinued chemotherapy and medication, clinical trial exclusion, and unnecessary medical procedures.

“This is a critical health equity issue that we need to address, and I’m proud that ASH and these esteemed health care institutions are working together to educate health care professionals, clinical trialists, and the public about the implications of DANC,” said Mohandas Narla, DSc, ASH president, and distinguished scientist at New York Blood Center Enterprises. “Race and ethnicity are not biological facts and are only used as a proxy for this research because this phenotype is most commonly found among those with African and Middle Eastern genetic ancestry. Beyond the implications of this effort for hematology, we are excited to be part of the larger Doris Duke Foundation initiative to re-examine if uses of race in clinical algorithms are grounded in current evidence.”

“Too often, differences in scientific observations about a biological phenomenon are attributed to race, with potentially detrimental consequences to patients,” said Sindy Escobar Alvarez, PhD, program director for medical research at the Doris Duke Foundation. “Testing for Duffy status recognizes that race is a poor predictor of low neutrophil counts that can lead to overdiagnosis of neutropenia in Black patients and preclude Duffy-null individuals from participating in important clinical studies.”

The project will examine ANC of pediatric patients based on Duffy status along a range of age brackets, as well as adult patients aged 18 and older. Project sites will capture 200 de-identified samples from each pediatric age bracket to establish new reference ranges. Institutions will reconsider adult reference ranges specific to their organization. The results of this work will have broad implications across health care systems.

ASH-awarded Duffy Project Institutions: 

• Atrium Health Carolinas Medical Center
• Banner MD Anderson Cancer Center
• Boston Medical Center
• Children’s Hospital of Philadelphia
• Children’s National Hospital
• Icahn School of Medicine at Mount Sinai
• Johns Hopkins University
• Mayo Clinic
• MD Anderson Cancer Center
• Montefiore Health System
• Nemours Children’s Hospital
• NewYork-Presbyterian/Weill Cornell Medical Center/Columbia University Irving Medical Center
• Northwestern University
• Norton Cancer Institute
• Rhode Island Hospital
• Saint Peter’s University Hospital
• St. Jude Children's Research Hospital
• University of North Carolina at Chapel Hill
• University of Alabama at Birmingham
• University of California, Los Angeles
• University of Connecticut
• University of Illinois Chicago
• University of Michigan
• Vanderbilt University Medical Center

The ANC by Duffy Status Project is supported by the Doris Duke Foundation. This work is in addition to ASH’s application to the National Center for Health Statistics’ ICD-10-CM Coordination and Maintenance Committee to establish new ICD-10 Z codes – the system by which health data such as diagnoses are recorded in electronic health records – for Duffy phenotype status. New Z codes will enable more accurate documentation, prevent unnecessary testing, and augment research. These new codes, included in the FY 2025 Hospital Inpatient Prospective Payment System proposed rule, are expected to be available for use starting October 1, 2024.

To learn more about the project, visit hematology.org/duffy. To learn about ASH’s broader diversity, equity, and inclusion efforts, visit hematology.org/DEI.

About the American Society of Hematology

The American Society of Hematology (ASH) (hematology.org) is the world’s largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. Since 1958, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology. 

The Blood journals (https://ashpublications.org/journals) are the premier source for basic, translational, and clinical hematological research. The Blood journals publish more peer-reviewed hematology research than any other academic journals worldwide. 

Contact:   
Melissa McGue, American Society of Hematology  
[email protected]; 202-552-4927