Matthew M. Hsieh, MD; James E. Everhart, MD, MPH; Danita D. Byrd-Holt; John F. Tisdale, MD; Griffin P. Rodgers, MD
Low neutrophil counts may be more common in certain ethnic groups and ages.
When blood count data were analyzed from a national sample of presumably healthy persons, the authors found that neutrophil counts were lower and neutropenia was more prevalent in U.S. black persons compared with white persons. Smoking was associated with increased neutrophil counts, especially in white persons.
Blood counts were measured only once and could have differed in a second measurement or changed over time.
Race and smoking status influence the number of blood neutrophils and should be taken into account when considering the need to evaluate abnormal counts.
Appendix Table 1.
Appendix Table 2.
Appendix Table 3 shows the actual percentages and number of participants.
Appendix Table 3.
The error bars refer to the standard errors. Appendix Table 4 shows the actual percentages and number of participants.
Appendix Table 4.
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Mukaila A Raji
University of Texas Medical Branch
May 20, 2007
Idiopathic neutropenia: a potential source of ethnic disparity in health care
Hsieh and colleagues concluded that benign neutropenia in US blacks (benign ethnic neutropenia) had implications for diagnostic evaluation of neutropenia in blacks (1). Benign neutropenia in US blacks also carries important therapeutic implications, especially as a potential source of ethnic disparity in treatment (and prognosis) for black patients with cancer and mental health conditions. Initiation, optimal dosing and duration of cancer chemotherapy depend, at least in part, on neutrophil count being within the normal range i.e. >1500/mm3 . In the face of benign ethnic neutropenia, there is a high likelihood that blacks with cancer (e.g. breast cancer) may not get optimal adjuvant chemotherapy (2). For example, Hershman and colleagues found that among women (43 blacks and 93 whites) with early stage breast cancer, black women had lower white blood cell count (wbc) cont, lower dose intensity of adjuvant chemotherapy and longer duration of cancer treatment (2). Another implication of benign neutropenia in blacks relates to under-use and increased discontinuation rate of clozapine in blacks with treatment-resistant schizophrenia (3-5). Clozapine has been shown to be effective for treatment-resistant schizophrenia (3-5). The use of clozapine is contraindicated in patients with wbc below 3500/mm3 or absolute neutrophil count <2000/mm3. Such contraindications based on the current wbc range may explain, in part, the lower use and high discontinuation rate of clozapine in blacks with treatment resistant schizophrenia (3). In a study of 1287 Caucasian and 588 African American patients on clozapine for treatment-resistant schizophrenia or schizoaffective disorder, blacks were about 2 times as likely as whites to have their clozapine discontinued as a result of leucopenia (4). In that study, all the patients (n=8) who developed agranulocytosis were white (4). A recent review by Mallinger and Lamberti emphasized the need for a US guideline that recognizes benign ethnic neutropenia and considers alternative normal wbc range for those with this condition, as has been done in Canada and the United Kingdom (3,5). I agree with Hsie et al. that clinicians should consider the possibility of benign ethnic neutropenia in their diagnostic evaluations. Such consideration should also extend to decision-making regarding optimal use of recommended therapies for cancer and schizophrenia. Such consideration may contribute to a reduction of health disparity in blacks.
1)Hsieh MM, Everhart JE, Byrd-Holt DD, Tisdale JF, Rodgers GP. Prevalence of neutropenia in the U.S. population: age, sex, smoking status, and ethnic differences. Ann Intern Med. 2007;146:486-92.
2)Hershman D, Weinberg M, Rosner Z, Alexis K, Tiersten A, Grann VR, et al. Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer. J Natl Cancer Inst. 2003;95:1545-8.
3)Mallinger JB, Lamberti JS. Clozapine--should race affect prescribing guidelines? Schizophr Res. 2006 ;83:107-8..
4)Kelly DL, Kreyenbuhl J, Dixon L, Love RC, Medoff D, Conley RR. Clozapine Underutilization and Discontinuation in African Americans Due to Leucopenia. Schizophr Bull, 2006;doi:10.1093/schbul/sbl068v1. PMID: 17170061
5)Rajagopal S. Clozapine, agranulocytosis, and benign ethnic neutropenia, Postgrad. Med. J. 2005;81:545"“46
Hsieh MM, Everhart JE, Byrd-Holt DD, Tisdale JF, Rodgers GP. Prevalence of Neutropenia in the U.S. Population: Age, Sex, Smoking Status, and Ethnic Differences. Ann Intern Med. 2007;146:486-492. doi: 10.7326/0003-4819-146-7-200704030-00004
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Published: Ann Intern Med. 2007;146(7):486-492.
Cardiology, Coronary Risk Factors, Smoking, Tobacco, Alcohol, and Other Substance Abuse.
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