The Duffy antigen: A narrative review of testing, epidemiology, neutrophil counts and clinical consequences
Stephen P. Hibbs
Wolfson Institute for Population Health, Queen Mary University of London, London, UK
Search for more papers by this authorJennifer Jones
Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorAndrew Hantel
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorCorresponding Author
Lauren E. Merz
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
Department of Hematology, Brigham and Women's Hospital, Boston, Massachusetts, USA
Correspondence
Lauren E. Merz, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA.
Email: lemerz@med.umich.edu
Search for more papers by this authorStephen P. Hibbs
Wolfson Institute for Population Health, Queen Mary University of London, London, UK
Search for more papers by this authorJennifer Jones
Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorAndrew Hantel
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorCorresponding Author
Lauren E. Merz
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
Department of Hematology, Brigham and Women's Hospital, Boston, Massachusetts, USA
Correspondence
Lauren E. Merz, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA.
Email: lemerz@med.umich.edu
Search for more papers by this author
Summary
The null variant of the Duffy antigen is a non-pathological mutation that is partially protective against Plasmodium vivax and results in a lower absolute neutrophil count (ANC) in peripheral blood without increasing the risk of infection. Healthcare practices, clinical trials eligibility and medication dosing are often influenced by the definition of neutropenia. In many regions, however, neutropenia has been defined by the ANC distribution of Duffy-positive individuals, which may be unsuitable for decision-making in Duffy null individuals. This review describes the association between Duffy status, Plasmodium vivax exposure, racial or ethnic groupings and ANC. We outline biological and iatrogenic associations between Duffy antigen status and health outcomes and recommend changes to healthcare practices required to ensure equity for Duffy null individuals.
Graphical Abstract
The null variant of the Duffy antigen is a non-pathological mutation that is partially protective against Plasmodium vivax and results in a lower absolute neutrophil count (ANC) in peripheral blood without increasing the risk of infection. Healthcare practices, clinical trials eligibility and medication dosing are often influenced by the definition of neutropenia. In many regions, however, neutropenia has been defined by the ANC distribution of Duffy-positive individuals, which may be unsuitable for decision-making in Duffy null individuals. This review describes the association between Duffy status, Plasmodium vivax exposure, racial or ethnic groupings and ANC. We outline biological and iatrogenic associations between Duffy antigen status and health outcomes and recommend changes to healthcare practices required to ensure equity for Duffy null individuals.
CONFLICT OF INTEREST STATEMENT
LEM has consulted for J&J and 23&Me. AH reports receiving personal fees from AstraZeneca, BMS, GSK and AbbVie (advisory boards), Indy Hematology Review and the American Journal of Managed Care (speaker's bureau), Jazz and Genentech (consultancy) and Real Chemistry (spousal employment).
DATA AVAILABILITY STATEMENT
The authors have nothing to report.
Supporting Information
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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