Guidelines are needed to advance health equity in hematology

TO THE EDITOR:

We appreciate the interest in our letter¹ describing the American Society of Hematology (ASH) Health Equity Compendium. The reply presents data addressing a gap we identified across the Blood journals: the relative lack of health equity articles studying classical hematologic conditions. These data add to only 1 other compendium article² characterizing disparities in iron deficiency screening/diagnosis. ASH is currently developing iron deficiency anemia clinical practice guidelines,³ with plans to address diagnostic testing, including thresholds defining iron deficiency in various populations. The reply, together with findings from others,^2,4 emphasizes the need for these guidelines to address disparities in the management of iron deficiency and iron deficiency anemia affecting women of reproductive age.

Guidelines highlight the priorities of a society/government and can mitigate structural bias by setting minimum acceptable standards and clear benchmarks of care delivery. For these reasons, they are important tools to address disparities across hematology. For example, guidelines could benefit individuals with Duffy-null associated neutrophil count (DANC), which disproportionately affects people of African/Middle Eastern ancestry. Individuals with DANC have lower absolute neutrophil counts than would be expected based on standard neutrophil reference ranges, increasing their risk of iatrogenic harm (eg, unnecessary marrow biopsies, inappropriate discontinuation of medications known to cause neutropenia, and clinical trial eligibility/enrollment barriers).⁵ ASH is currently leading a multicenter initiative to mitigate these disparities through reconsideration of neutrophil reference ranges by Duffy status. In addition to this important work, guidelines should be developed to standardize DANC screening, diagnosis, and management in healthy individuals and across disease states (eg, autoimmune conditions and malignancy). In another example, there is a need for stem cell donor suitability guidance which protects donors and patients while minimizing discrimination against donors from racialized/sexual and gender minority populations (eg, in health-screening questionnaires⁶). To address this unmet need, the World Marrow Donor Association's Donor Medical Suitability Committee is developing guidelines outlining inclusive practices for safe and equitable donor assessments. Adoption of these and other hematology health equity guidelines will advance a more inclusive health care system.

Contribution: W.B.F. wrote the reply; and all authors reviewed and approved the final version of the manuscript.

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Correspondence: Warren B. Fingrut, Division of Cancer Medicine, Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, 1515 Holcolmbe Blvd, Houston, TX 77030; email: wbfingrut@mdanderson.org; and Angela C. Weyand, Division of Hematology/Oncology, Department of Pediatrics, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109; email: acweyand@med.umich.edu.