A new illustrated review published in the journal Research and Practice in Thrombosis and Haemostasis makes the case that many established reference intervals (RIs) used to interpret the results of laboratory tests are biased and highly problematic. This is significant as RIs are central to the process for determining whether any given lab results are deemed normal or abnormal via predetermined ranges.
Authors of the review posit that RIs such as those utilized in thrombosis and hemostasis, are based on structural and deeply rooted inequities such as systemic racism and sexism. They argue that this dynamic has perpetuated a cycle in hematology whereby heavy menstrual bleeding (HMB) linked to conditions like anemia or iron deficiency are “inappropriately” normalized in women, and especially in Black women. In addition, women with von Willebrand disease (VWD) will, in many instances suffer from HMB and other complications, for many years before receiving a diagnosis – this is a result of normalization and under-assessment on the part of some healthcare providers. This is further complicated by the complexities of interpreting labs associated with von Willebrand factor (VWF), which should be conducted in wider and more inclusive context that includes estrogen status, recent stress, blood type, among other variables.
Citing several research case studies, the authors detail many of the current RIs used to assess a number of hematologic conditions and highlights particular disparities, including those used for sex-based hemoglobin, race-based hemoglobin, heavy menstrual bleeding, iron deficiency and coagulopathy. It also includes a review on the impact of both sex and race in our common understanding of VWF.
The review culminates in a series of action items including a call to remove race-based RIs and reevaluate sex-based ones rooted in weak evidence based on a high risk of bias; use broad population based data sets to prioritize and track quality indicators in health in equity-deserving groups to reduce health disparities; foster and fund inclusive health research via recruitment of diverse participants to promote generalizability of research findings; prioritize research areas of extreme health disparity, particularly at vulnerable intersections of social identity such as pregnancy research among Black women and those living with sickle cell disease.
“We must actively unlearn dogmatic medical beliefs and learn anew with updated data and understanding,” emphasized the authors. The full review “Laboratory-based Inequity in Thrombosis and Hemostasis: Review of the Evidence,” is currently available online, including in PDF.
Citation
Merz LE, Siad FM, Creary M, Sholzberg M, Weyand AC. Laboratory-based inequity in thrombosis and hemostasis: review of the evidence. Res Pract Thromb Haemost. 2023 Mar 15;7(2):100117. doi: 10.1016/j.rpth.2023.100117. PMID: 37063772; PMCID: PMC10099330.
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