Eliminating race-based reference ranges in haematology: a call to action

Area of Science:

• Haematology
• Medical Diagnostics
• Health Equity

Background:

• Reference intervals for laboratory variables are crucial in haematology for disease diagnosis and treatment decisions.
• Haematological variables like haemoglobin and iron indices are often reported with different thresholds based on race or ethnicity.
• Using race as a basis for defining normal values is a social construct, not a physiological difference, and can perpetuate harmful misperceptions.

Purpose of the Study:

• To argue for the removal of race-based reference intervals in haematology.
• To highlight the unacceptability of defining pathology based on social constructs like race.
• To address the downstream effects of race-based intervals on diagnostic and treatment decisions that exacerbate racial health disparities.

Main Methods:

• This viewpoint critically analyzes the use of race-based reference intervals in haematology.
• It examines the scientific and ethical implications of these practices.
• The authors advocate for a paradigm shift in laboratory diagnostics.

Main Results:

• Race-based reference intervals validate misperceptions of physiological differences between racial groups.
• These intervals can lead to diagnostic and treatment disparities.
• The current practice is scientifically unacceptable and ethically problematic.

Conclusions:

• Race-based reference intervals in haematology should be removed.
• Eliminating these intervals is essential for promoting health equity.
• Accurate and equitable patient care requires abandoning race as a factor in laboratory reference values.