Laboratory-based inequity in thrombosis and hemostasis: review of the evidence

The concept of normal in hematology, similar to that in other areas of medicine, is anchored to the perspective of those setting the standard. This means that several laboratory reference intervals and approaches to the conditions of thrombosis and hemostasis are influenced by the vantage point of those in power. Structural inequity, including systemic racism and sexism, can lead to inappropriate normalization of disease states, such as anemia or iron deficiency, or delayed diagnoses, such as in von Willebrand disease. This review will focus on how laboratory reference intervals perpetuate the cycles of inequity in care of patients with disorders of thrombosis and hemostasis. We provide examples and case studies in maternal mortality as well as in disorders such as von Willebrand disease and iron deficiency, question physiology versus pathophysiology, acknowledge the distinction between social constructs and biologic influence, and highlight opportunities for much-needed restructuring in areas such as defining anemia and iron deficiency.