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June 10, 2026Hematology Reports0 citationsOpen Access

Establishing Reference Intervals for White Blood Cell and Absolute Neutrophil Counts in Duffy Null Individuals

MBMohammad Barouqa MAMuhammad Ashfaq KJK Jiang

Key Points

This study aims to establish reference intervals for white blood cell and absolute neutrophil counts in individuals with the Duffy-null phenotype.
Conducted a retrospective analysis of 1695 patients with complete blood count testing between 2020 and 2026.
Included 122 healthy individuals with confirmed Duffy-null phenotype Fy(a−b−).
Established reference intervals using nonparametric methods per Clinical Laboratory Standards Institute guidelines.
Median WBC in Duffy-null individuals was 3.24 × 103/µL compared to 6.65 × 103/µL in institutional reference medians (p < 0.01).
Median ANC in Duffy-null individuals was 1.45 × 103/µL compared to 4.45 × 103/µL in institutional reference medians (p < 0.01).
Derived 95% reference intervals for WBC (2.43–7.05 × 103/µL) and ANC (1.01–4.34 × 103/µL) fall below conventional thresholds.

Abstract

Background/Objectives: The Duffy (Fy) blood group system, encoded by the ACKR1 gene, plays a key role in transfusion medicine and host susceptibility to malarial infections such as Plasmodium vivax. The Duffy-null phenotype Fy(a−b−) is associated with lower baseline white blood cell (WBC) and absolute neutrophil count (ANC) values despite a benign clinical course. This study aimed to establish specific reference intervals for WBC and ANC in Duffy-null individuals to improve diagnostic accuracy and reduce unnecessary clinical interventions. Methods: We conducted a retrospective analysis of 1695 adult patients who underwent complete blood count testing and red blood cell phenotyping between 1 January 2020 and 1 January 2026. Among these, 122 healthy individuals with confirmed Fy(a−b−) phenotype met inclusion criteria. Reference intervals were established using 95% reference interval nonparametric methods in accordance with Clinical Laboratory Standards Institute (CLSI) guidelines. Results: The median WBC and ANC values in the Duffy-null cohort were significantly lower than institutional reference medians (3.24 vs. 6.65 × 103/µL and 1.45 vs. 4.45 × 103/µL, respectively; p < 0.01). The derived 95% reference intervals (WBC: 2.43–7.05 × 103/µL; ANC: 1.01–4.34 × 103/µL) fell below conventional thresholds, with the lower ANC bound below the standard neutropenia cutoff. Conclusions: These findings support the need for Duffy-null-specific hematologic reference ranges. Adoption of such intervals may reduce misclassification, avoid unnecessary diagnostic procedures, and promote personalized clinical care.

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