The Laboratory Test Range That Was Never Built for Me

My WBC, white blood cell count, has been "low" since at least 2013. Flagged. Noted. Followed up on.

In 2024, it dropped low enough that my provider ordered a hematology consult. The specialist's notes listed three possibilities: a primary bone marrow disorder, a vitamin deficiency, or benign ethnic neutropenia.

The workup came back clear. No marrow disorder. Vitamin levels fine.

What was left was the one explanation that had been sitting there for over a decade: this might just be normal, for me.

Half of Us Are "Abnormal" by This Math

Here's a number that changes everything: approximately half of African Americans have WBC and neutrophil counts lower than the normal ranges reported by most laboratories. Neutrophils are a type of white blood cell, and ANC, absolute neutrophil count, is the specific measurement most often flagged.

The standard ANC reference range for most adults is 1.5 to 8.0 K/µL (1,500-8,000 cells/µL). Below that, labs typically classify mild neutropenia as 1.0-1.5, moderate as 0.5-1.0, and severe as below 0.5.

Half.

These reference ranges were historically established based on populations of European descent. A lower baseline ANC is linked to the Duffy-null phenotype, present in 80-100% of people of sub-Saharan African ancestry and less than 1% of those of European descent, originally a genetic trait that provides protection against certain strains of malaria.

So for roughly half of Black Americans, a perfectly healthy, genetically normal ANC, often sitting just below 1.5, can fall into the "mild neutropenia" category on paper, triggering follow-up for something that's simply how their body normally works.

Why the Word "Benign" Still Stings

For years, the medical term for this was "benign ethnic neutropenia." Researchers have pointed out that the word "benign" implies there's an abnormality to begin with, when what's actually being described is a normal, healthy variant that simply doesn't match a range built for someone else's biology.

Scientists are now moving away from "BEN" toward "Duffy-null associated neutrophil count," or DANC, language that reflects a normal variant rather than a deficiency.

That shift in language matters. "You have a benign condition" and "this is simply how your body normally works" are different sentences, even when they're describing the exact same lab value.

This Isn't Just About One Number

I want to be clear about what this is and isn't. This isn't a story about a doctor getting something wrong. Every provider who flagged my WBC was doing exactly what they were trained to do, following the reference range in front of them.

But there are documented real-world consequences to this gap. In oncology, benign ethnic neutropenia in Black patients can lead to unnecessary dose reductions in chemotherapy, and some research has linked this to disparities in breast cancer survival outcomes.

A range that doesn't reflect a population isn't just an inconvenience. In some contexts, it can shape treatment decisions.

A Pattern Within the Pattern

There's something else I've noticed, something that goes beyond a simply lower baseline.

Every time I'm in a histamine intolerance flare, heavy inflammation, the crawling skin sensation, the brain fog, my WBC drops further. Not just slightly low. Noticeably lower than my own usual "low."

One of my siblings has the same histamine intolerance, and the same pattern. She's also been through a hematology consult. Same conclusion: benign.

I'm not a researcher, and I want to be careful not to overstate this. But two siblings with the same sensitivity, the same lab fluctuation pattern, and the same "benign" conclusion is, at minimum, worth someone studying. If a baseline DANC variant exists alongside a histamine-driven fluctuation on top of it, that's two layers of "normal for us" that standard reference ranges and standard workups may not be designed to separate.

Naming It

For years, naming it meant something quiet: every time my WBC comes back low, I brace for what comes next, more tests, more referrals, more appointments to explain a number that may have never needed explaining.

There was a fear underneath that bracing, one I hadn't fully named until writing this: the fear that one day, "probably benign" would turn out to be wrong, and nobody would catch it in time because everyone had stopped looking closely.

Eleven years. That's how long this number sat on my charts before anyone said the words "benign ethnic neutropenia" out loud, and before I let myself name what I'd actually been afraid of the whole time.

Breaking It

Breaking it didn't mean refusing future monitoring; ongoing follow-up is reasonable and I'm not suggesting anyone skip it. It meant holding two things at once: taking results seriously, while also asking, every time, could this be the range, not me?

It also meant praying through the waiting. Every referral and consult came with a few days of not knowing, and prayer was where I put the fear while I waited for the answer. Not instead of the appointment. Alongside it.

Voicing It

I spent many years working in laboratory settings. I have run, reviewed, and validated these exact tests. I have done comparative testing of these same tests on different instrument. And it still took a hematology referral, eleven years after this first showed up on my chart, for anyone to say out loud that my "low" number might simply be normal for someone like me.

If it took that long for someone with my background, I think about how many people never get that sentence said to them at all, and how many of them are sitting with the same quiet fear I carried for over a decade, never saying it out loud either.

What This Means for You

If you've been told your white blood cell count or neutrophil count runs "low," and you're of African, Middle Eastern, or certain other ancestries, ask directly: is this benign ethnic neutropenia, or DANC? Has that been ruled in, not just ruled out?

It's a different question than "is something wrong with me," and it deserves its own conversation.

Practical Takeaway

If a lab value has been flagged as abnormal year after year with no other symptoms, ask your provider: has population-specific reference range research been considered for this result? Researchers are actively calling for Duffy-null-specific reference ranges to be developed, this is an active, evolving area, not settled science, and it's reasonable to ask where things currently stand.

This Conversation Is Bigger Than One Lab Value

When half a population's normal looks "abnormal" on paper, that's not a personal health story. That's a systems story, one with real implications for how confidently people trust their own results, and in some cases, how they're treated.

Representation in research, and in the rooms where reference ranges get built, isn't an abstract diversity issue. It's the difference between a lab report that reassures you and one that sends you down a decade-long road of unanswered questions.

This is the same conversation I bring into corporate rooms and women's events: fear that gets normalized instead of named, and burnout that goes unaddressed because nobody connected the dots. Whether it's a lab value or a workload, the pattern is the same, years of quiet adjustment to something that was never built with you in mind, until someone finally says it out loud.

I bring this conversation into women's events and organizations through Breaking Your Agreement With Fear and Burnout Is a Signal Not a Shame.

Book a keynote or workshop: trulyflavius.com/booktrulyflavius

#WomensHealth #HealthEquity #BenignEthnicNeutropenia #BlackWomensHealth #BreakingYourAgreementWithFear #SisYoureNotAlone #PatientAdvocacy #HighAchievingWomen #DuffyNull