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Volume 18
Issue 3
10.3390/hematolrep18030038
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Article

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

by
Mohammad Barouqa
1,*,
Muhammad Areeb Ashfaq
2,
Katrina J. Jiang
1,
Huseyin Kilic
1,
Nestor Dela Cruz
1,
Aariez Khalid
3 and
Marianne E. Yassa
1
1
Department of Pathology, University of South Alabama, 2451 University Hospital Dr, Mobile, AL 36617, USA
2
Department of Internal Medicine, Hematology and Medical Oncology Division, University of South Alabama, 2451 University Hospital Dr, Mobile, AL 36617, USA
3
Department of Internal Medicine, University of South Alabama, 2451 University Hospital Dr, Mobile, AL 36617, USA
*
Author to whom correspondence should be addressed.
Hematol. Rep. 2026, 18(3), 38; https://doi.org/10.3390/hematolrep18030038
Submission received: 18 April 2026 / Revised: 31 May 2026 / Accepted: 3 June 2026 / Published: 8 June 2026
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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.
Keywords: Duffy-null; neutropenia; leukopenia; absolute neutrophilic count; white blood cell count Duffy-null; neutropenia; leukopenia; absolute neutrophilic count; white blood cell count

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MDPI and ACS Style

Barouqa, M.; Ashfaq, M.A.; Jiang, K.J.; Kilic, H.; Dela Cruz, N.; Khalid, A.; Yassa, M.E. Establishing Reference Intervals for White Blood Cell and Absolute Neutrophil Counts in Duffy Null Individuals. Hematol. Rep. 2026, 18, 38. https://doi.org/10.3390/hematolrep18030038

AMA Style

Barouqa M, Ashfaq MA, Jiang KJ, Kilic H, Dela Cruz N, Khalid A, Yassa ME. Establishing Reference Intervals for White Blood Cell and Absolute Neutrophil Counts in Duffy Null Individuals. Hematology Reports. 2026; 18(3):38. https://doi.org/10.3390/hematolrep18030038

Chicago/Turabian Style

Barouqa, Mohammad, Muhammad Areeb Ashfaq, Katrina J. Jiang, Huseyin Kilic, Nestor Dela Cruz, Aariez Khalid, and Marianne E. Yassa. 2026. "Establishing Reference Intervals for White Blood Cell and Absolute Neutrophil Counts in Duffy Null Individuals" Hematology Reports 18, no. 3: 38. https://doi.org/10.3390/hematolrep18030038

APA Style

Barouqa, M., Ashfaq, M. A., Jiang, K. J., Kilic, H., Dela Cruz, N., Khalid, A., & Yassa, M. E. (2026). Establishing Reference Intervals for White Blood Cell and Absolute Neutrophil Counts in Duffy Null Individuals. Hematology Reports, 18(3), 38. https://doi.org/10.3390/hematolrep18030038

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