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Leukopenia and Neutropenia
RGA's comprehensive guide for reviewing the updated underwriting guidelines for these blood disorders.
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Welcome
Following our recent anemia update, we’ve expanded our hematology guidance with updated underwriting guidelines for leukopenia and neutropenia. These refinements reflect our ongoing commitment to providing underwriters with the most current, clinically grounded tools for evaluating complex conditions.
Highlights of this latest update include:
A refreshed topic overview that clearly explains the critical role of white blood cells (WBCs) and neutrophils in immune function, and why assessing leukopenia and neutropenia together provides a more complete picture of hematologic health.
Streamlined rating tables for both conditions, now integrated on a single page for ease of use. Outcomes are based on combined WBC and neutrophil counts, offering a more nuanced and practical approach to risk assessment. Please note that agranulocytosis has been removed from the table to simplify and focus the guidance.
Competitive, holistic guidelines that span both mortality and morbidity considerations, enabling more accurate and confident risk stratification.
To support your continued learning and application of these updates, we’ve shared two engaging e-learning modules available via the Learning Gateway tab:
explore the Blood – A foundational module that dives into the components and functions of blood, setting the stage for deeper understanding.
accelerate Blood Tests – A practical guide to interpreting blood test results in the context of underwriting.
RGA remains committed to equipping you with the tools needed for confident, informed underwriting decisions. Please reach out if we can support your team further.
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For more information on these updates, log in to the Global Underwriting Manual.
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©2025 RGA, All rights reserved. RGA has made all reasonable efforts to ensure that the information provided in this publication is accurate at the time of inclusion and accepts no liability for any inaccuracies or omissions. Links to external websites are provided for informational purposes only. RGA bears no responsibility for the accuracy, legality, or content of external websites.
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Sandeep Kumar
Chief Manager Global Underwriting Philosophy Delivery
CONTACT US: For further information or to connect with your regional contact, email GUMHelp@rgare.com.
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As Executive Director, Global Underwriting Manuals, Research and Development, Rebecca Abayakoon is responsible for leading the research team that advances RGA’s competitive position through strategic content development in the underwriting manual. Prior to joining RGA in 2010, Rebecca worked with several companies, including SCOR Global Life and XL Re Ltd. With more than 20 years of underwriting development expertise with manuals, Rebecca has global experience working with audits, in-depth research, and complex cases. Rebecca received her Bachelor of Commerce degree in commercial law and management from Victoria University of Wellington, New Zealand. She is a member of the Fellow Academy of Life Underwriting and is a recognized Certified Insurance Professional by the Australian and New Zealand Institute of Insurance and Finance.
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Rebecca Abayakoon
Executive Director, Global Underwriting Manuals, Research, and Development
Akhilesh Pandey is Associate Director of Underwriting Research and Manual Development and a member of RGA’s Global Underwriting team. Akhilesh develops and publishes research-based underwriting guidelines for RGA's Global Underwriting Manual for Mortality and Morbidity benefits. Akhilesh also writes and shares internal and external communication materials related to the manual and provides training to RGA offices on various medical and non-medical underwriting topics. Akhilesh earned his FALU and FLMI designations in 2022 and 2023, respectively, and holds a Bachelor of Pharmacy from NCRD Sterling Institute of Pharmacy in Mumba
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Akhilesh Pandey
Associate Director - Global Underwriting, Manual Research
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Anemia is a deficiency of red blood cells or of hemoglobin that affects up to one-quarter of the world’s population. While anemia is a common impairment, it is often asymptomatic and may go undetected. A basic knowledge of physiology, along with consistent analysis of blood test results, can identify the type of anemia and can aid in determining whether there is a mortality risk. In this presentation, Dr. Duckett explains the root causes of anemia and how four key CBC indices can be useful in its identification.
Presentation time: 14:51 mins
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Underwriting Anemia
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As Chief Manager, Sushama Singh spearheads underwriting research and the content development of RGA's Global Underwriting Manual. She holds degrees in Medicine and Law from Mumbai University and an ALMI designation by LOMA. With 18 years of underwriting experience, Sushama has expertise in handling high-net-worth cases, product development, reinsurance treaty discussions, underwriting manual governance and interpreting treadmill tests (TMT) and ECGs.
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Sushama Singh
Chief Manager - Research and Manual Development
Global Underwriting Hub Q2
This module of our explore series offers an overview of the components and functionality of blood in the human body.
explore courses are designed for entry level and junior underwriting staff (0-5 years experience). Estimated Completion Time: 25-35 minutes
explore:
The Blood
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Participants in this course will gain a thorough understanding of how to:
Explain the utility of blood tests in the underwriting context
Identify the blood tests commonly used in mandatory and discretionary underwriting
Recognize the purpose of blood tests often seen in clinical medical records
Identify the types of abnormalities that are commonly detected using blood tests and the broad implications of each
accelerate courses are designed for senior underwriting staff (7+ years experience). Estimated Completion Time: 100-120 minutes
accelerate:
Blood Tests
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Sandeep is a postgraduate in management and a distinguished fellow of both the Insurance Institute of India and the Academy of Life Underwriting. With over a decade of direct insurance underwriting experience, he brings deep expertise in risk assessment and decision-making. Currently focused on the research and development of the Global Underwriting Manual, Sandeep combines his technical knowledge with practical insights to enhance underwriting standards worldwide. His hands-on experience in digitization and rule-building has been instrumental in driving automation and innovation in underwriting processes.
Review the updated underwriting guidelines for Leukopenia and Neutropenia.
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RGA's Dr. Maryam B. Shapland, Vice President and Medical Director, U.S. Mortality Markets, explores reactive thrombocytosis, a condition associated with higher mortality in acutely ill patients, in Reflections and also in On the Risk, the Journal of the Academy of Life Underwriting.
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CONTACT US: For further information or to connect with your regional contact, email Learning@rgare.com.
Diana Myers
Executive Director, Global Underwriting Education
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Miriam de Jonge
Head of Global Underwriting Education
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Sushama Singh
Chief Manager - Research and Manual Development
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Meet the Learning Gateway team
Diana Myers is the Executive Director, Global Underwriting Education at RGA. After a brief stint in merchandising, she found her true calling in training and instructional design, and for more than 30 years, she has developed courses on everything from managerial soft skills to understanding genetics in insurance. Diana has been with RGA for more than 12 years. An eLearning designer and developer, she focuses on adult learning principles as she strives to create courses that respect each learner’s experience.
Diana served as the chair of the St. Louis Articulate Storyline Special Interest Group for more than five years and is a regular contributor on Articulate’s e-Learning Heroes community. She is a Wisconsin native and a graduate of the University of Wisconsin.
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Diana Myers
Executive Director, Global Underwriting Education
As Chief Manager, Sushama Singh spearheads underwriting research and the content development of RGA's Global Underwriting Manual. She holds degrees in Medicine and Law from Mumbai University and an ALMI designation by LOMA. With 18 years of underwriting experience, Sushama has expertise in handling high-net-worth cases, product development, reinsurance treaty discussions, underwriting manual governance and interpreting treadmill tests (TMT) and ECGs.
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Sushama Singh
Chief Manager - Research and Manual Development
Miriam’s career spanned 20 years with the Australian life insurance market in a variety of underwriting and claims roles with both direct carriers and reinsurers. She began her career at RGA in the Australia office as Technical Underwriting Manager before joining the International Division to support RGA’s Asia Pacific region and to develop an underwriting training platform (which became the industry-leading Learning Gateway).
Among other certifications, Miriam holds a Bachelor of Commerce (accounting) with honors, from Deakin University, Warrnambool. She is a founding Senior Associate of the Australian Underwriting Claims Association (ALUCA), and a Fellow of the Academy of Life Underwriting (FALU). She has been an active member of various underwriting and training-related industry associations throughout her career.
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Miriam de Jonge
Head of Global Underwriting Education
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John Cardus
Vice President, Head of Underwriting Manual Development
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Learning Gateway features 12 comprehensive modules specifically focused on alcohol and substance abuse, providing in-depth knowledge on these critical topics. Beyond these specialized modules, we invite you to sign into our RGA Central portal and click the Learning Gateway tile to explore our extensive library of over 375 resources tailored specifically for underwriters and claims assessors. These resources cover a wide range of topics and are designed to enhance your professional knowledge, improve decision-making skills, and keep you updated on industry trends.
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The Rise of Hematopoietic Stem Cell Transplantation
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Reactive Thrombocytosis: A Benign Entity?
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Head of Global Underwriting Philosophy Design
Review the latest asthma underwriting guidelines that feature updated information for accurate risk assessment. Also review, the updated guidelines for Hodgkin lymphoma. This includes expanded rating tables, risk classification guidance, and insights on etiology, signs and symptoms, and treatment toxicity.
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Asthma and Hodgkin Lymphoma
spark:
Underwriting Anemia
Anemia is a deficiency of red blood cells or of hemoglobin that affects up to one-quarter of the world’s population. While anemia is a common impairment, it is often asymptomatic and may go undetected. A basic knowledge of physiology, along with consistent analysis of blood test results, can identify the type of anemia and can aid in determining whether there is a mortality risk. In this presentation, Dr. Duckett explains the root causes of anemia and how four key CBC indices can be useful in its identification.
Presentation time: 14:51 mins
Explore more
explore:
The Blood
This module of our explore series offers an overview of the components and functionality of blood in the human body.
explore courses are designed for entry level and junior underwriting staff (0-5 years experience)
Estimated Completion Time: 25-35 minutes
Explore more
accelerate:
Blood Tests
Participants in this course will gain a thorough understanding of how to:
Explain the utility of blood tests in the underwriting context
Identify the blood tests commonly used in mandatory and discretionary underwriting
Recognize the purpose of blood tests often seen in clinical medical records
Identify the types of abnormalities that are commonly detected using blood tests and the broad implications of each
accelerate courses are designed for senior underwriting staff (7+ years experience). Estimated Completion Time: 100-120 minutes
Explore more
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© 2025 RGA, All rights reserved. RGA has made all reasonable efforts to ensure that the information provided in this publication is accurate at the time of inclusion and accepts no liability for any inaccuracies or omissions. Links to external websites are provided for informational purposes only. RGA bears no responsibility for the accuracy, legality, or content of external websites.
Connect with us
Trusted partner.
Proven results.