American Society for Clinical Pathology and American Society for Clinical Laboratory Science

View all recommendations from this society

November 7, 2022

Don’t perform an extensive work-up in otherwise healthy neutropenic patients of African or Middle Eastern ancestry prior to Duffy-null phenotype testing.

Individuals, typically of African or Middle Eastern ancestry, may present with an ANC <1500 cells/μL with no signs of recurrent infections, immunocompromise, or malignancy. Frequently, the lower ANC is a normal variant associated with the red blood cell Duffy-null phenotype [Fy(a-b-)] that should be confirmed by Blood Bank phenotyping. Asymptomatic Duffy-null individuals do not require additional testing and should not be denied clinical trial participation or prescription of certain medications (including chemotherapy) based on ANC alone.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items
on this list or their individual situation should consult their physician.

How The List Was Created

(1–4) The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Effective Test Utilization Steering Committee. This committee is chaired by an ASCP Past President and is comprised of subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered a list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees and councils. In addition, an announcement was made to ASCP’s Advisory Board seeking suggestions for possible recommendations to promote member involvement. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs and a more effective use of our laboratory resources and personnel.

(5) This recommendation was developed under the leadership of ASCLS’s Choosing Wisely Committee and the ASCLS Board of Directors. The Committee examined numerous options based on evidence available. Subject matter experts from the ASCLS Scientific Assemblies reviewed, edited, and recommended approval of this recommendation, which was subsequently reviewed and approved by the ASCLS Board of Directors.


Merz LE, Achebe M. When non-Whiteness becomes a condition. Blood. 2021. 137(1):13-15.