April was National Minority Health Month (NMHM), a time where additional focus and awareness is placed on the importance of health outcomes, education, and initiatives that impact marginalized communities. As a patient-centric organization, ASCP is engaged in activities that address health equity and strive to make a holistic impact on the health care system.
One such ASCP initiative involves advocating for the establishment of a national patient-centered red blood cell (RBC) antibody exchange to aid sickle cell disease and other patients. Through collaboration with AABB, ASH, Yale, ABC and other stakeholders, ASCP has convened a coalition to discuss the necessity of, and promote the creation of a database to reduce the amount of incompatible RBC transfusions that occur. According to ASCP Past President Dr. Kim Sanford, “Antigen-matching RBC for sickle cell patients is essential, due in part to the risk of erythrocyte alloimmunization, which can lead to life-threatening delayed hemolytic transfusion reactions. Such a reaction further complicates the task of finding appropriately matched RBC and can cause transfusion delays. To reduce the risk of alloimmunization, SCD patients need appropriately antigen-matched RBC.” The creation of a nationwide, centralized blood antigen database can expedite the process of finding antigen-matched red blood cells and improve health outcomes for sickle cell disease patients.
Another initiative that ASCP is involved in to improve health equity addresses a reference range issue that impacts individuals from areas where malaria is endemic. Some of these individuals, commonly of African or Middle Eastern ancestry, have an absolute neutrophil account (ANC) <1,500 cells/μL without increased risk of infection. This lower ANC is associated with the Duffy null [Fy(a- b-)] red blood cell phenotype and historically termed “Benign Ethnic Neutropenia (BEN).” In collaboration with ASH, Women and Brigham’s Hospital, and other stakeholders, the new term “Duffy null associated neutrophil count (DANC)" has been proposed that accurately describes the genetic driver of this normal variant. Many hospitals utilize ANC reference ranges that do not account for the lower ANC observed in some individuals with the Duffy null phenotype. Due to these exclusionary reference ranges, some individuals are not eligible to receive certain medications, chemotherapy, or participate in some clinical trials. ASCP has initiated the creation of a one-pager to educate the field about this reference range issue, and has also submitted a recommendation to ASCP’s Effective Test Utilization Committee.
ASCP will continue to support efforts that improve the health outcomes of racial and ethnic minorities and are hopeful that the work we are currently engaged in will produce meaningful, sustainable results.