Is There Something Wrong With Me?
I have had several patients ask me why the white blood cell (WBC) count on their CBC (complete blood count) panel was flagged (or red) as abnormal.
After digging deeper into the lab result, they saw this:
This is a classic example of benign ethnic neutropenia — a normal variation that shows up disproportionately in Black patients. There is nothing wrong with this result, and it does not call for further testing. It gets flagged as “abnormal” only because most reference ranges were established using research done on predominantly White populations.
Benign Ethnic Neutropenia
In many racial groups, but mainly in African Americans, these symptom-free reductions in white blood cell count are caused by lower neutrophil counts. A neutrophil is a type of white blood cell that fights infection. Benign ethnic neutropenia is also more common in people with roots in North Africa, the Middle East, and South Asia — and the cause has a name: a variant in the ACKR1 (Duffy) gene on chromosome 1, identified in a landmark 2009 genetic study. The variant changes how neutrophils circulate in the blood; it does not weaken the immune system.
Healthy African Americans with low neutrophil counts are still routinely sent for expensive, unnecessary testing — or have treatment delayed — for an otherwise harmless finding. Research out of Columbia University found that roughly a quarter to a third of Black Americans meet standard criteria for neutropenia, far more than in White Americans. The stakes are not just academic: oncologists have historically reduced or delayed chemotherapy doses in Black patients because their neutrophil counts looked too low to treat safely, even when those counts were normal for that patient.
Am I Affected?
Benign ethnic neutropenia affects an estimated 1 in 22 African American men and 1 in 40 African American women, compared with roughly 1 in 126 White Americans. In African Americans, low neutrophil counts are linked to that same ACKR1 (Duffy-null) variant on chromosome 1, which affects how neutrophils are produced and released — not how well the immune system works. It has been studied extensively, including in NIH-funded genetic research, and consistently found to have no impact on health.
There May Be a Health Benefit
Some research has found that patients with these lower neutrophil counts actually have lower rates of infection and chronic disease, not higher. Benign ethnic neutropenia usually runs in families, so a more detailed family history in a patient with a low WBC can help confirm it as the cause.
Once benign ethnic neutropenia is identified and documented in a patient’s history, no extensive monitoring, testing, or change in care is needed.
This is just one of many biological differences that affect how African Americans are diagnosed and treated — and it’s exactly why I wrote Better Black Health: A Comprehensive Guide in the Age of Precision Medicine. If a low WBC has ever worried you or someone in your family, it’s worth a read.
It’s also why I formulated GNetX Sequence multivitamins around what the research actually shows about Black health, rather than a one-size-fits-all standard.
