Anemia in the Elderly
Anemia in the Elderly
Eligible elderly men and women with anemia will undergo a full hematologic evaluation plus
 additional laboratory tests to determine the etiology of the anemia. In a subset of subjects,
 bone marrow aspirate and biopsies will be obtained for a planned analysis of erythroid
 progenitor and stem cells. Plasma; serum; and bone marrow samples will be will be compared to
 elderly non-anemic controls. Bone marrow samples will also be compared to non-anemic young
 controls (purchased).
Eligible elderly men and women with anemia will undergo a full hematologic evaluation (blood
 sample for complete blood count, CBC) to determine the etiology of the anemia (eg,
 myelodysplastic syndrome). Peripheral smears; iron studies; serum creatinine; serum
 erythropoietin; reticulocyte count; vitamin B12; and folate levels may be obtained/conducted.
 When no etiology is identified (ie, "unexplained anemia"), additional laboratory tests will
 be performed which will include some or all of urinary hepcidin levels; plasma cytokine
 levels; serum soluble transferrin receptor; C-reactive protein; erythrocyte sedimentation
 rate; D-Dimer; neopterin level; tryptophan level; and blood for a cytokine profile that may
 include IL-1, IL-6, TNF-alpha, and VEGF levels. Serum; plasma; and nucleated peripheral blood
 cells may be banked for future DNA and other analyses. In a subset of those found to have
 either unexplained anemia (approximately 6 to 30 subjects) or anemia of chronic inflammation
 (approximately 6 to 30 subjects) , bone marrow aspirate and biopsies may be performed for a
 planned analysis of erythroid progenitor and stem cells in these populations. In addition,
 plasma and serum and bone marrow samples will be obtained from elderly non-anemic controls
 (approximately 6 to 30 subjects), and bone marrow samples will be purchased for non-anemic
 young controls (approximately 6 to 30 subjects) .
INCLUSION CRITERIA: Anemic elderly :

 -  Age 65 or older

 -  Hemoglobin < 13 g/dL (men) or < 12 g/dL (women) on at least 2 occasions 30 days apart,
 with the most recent value within at least 14 days of enrollment into the study. In
 addition, if a CBC is drawn on the date of enrollment, hemoglobin must meet
 eligibility criteria in order for the patient to enroll.

 -  Outpatient at either the Stanford Health Care (SHC) Medical Center or VA Palo Alto
 Health Care System

 -  Independent/community living

 -  Ability to understand and the willingness to sign a written informed consent document

 -  Performance level ECOG 2 or better.

 INCLUSION CRITERIA: Non-anemic elderly control, for blood and urine samples, with or
 without bone marrow biopsy

 -  Age 65 or older

 -  Hemoglobin ≥ 13 g/dL (men) or ≥ 12 g/dL (women) within at least 90 days of enrollment
 into the study

 -  Normal white blood cell and platelet counts

 -  Independent / community living

 -  Ability to understand and the willingness to sign a written informed consent document

 -  Performance level ECOG 2 or better

 -  Matched to UA population by gender and 10-year age strata (65 to < 75; 75 to < 85; 85
 or older).

 INCLUSION CRITERIA: Non-anemic adult control (non-elderly), for blood and urine samples,
 with bone marrow biopsy

 -  Age 20 to 35

 -  Hemoglobin ≥ 13 g/dL (men) or ≥ 12 g/dL (women) within at least 90 days of enrollment
 into the study

 -  Normal white blood cell and platelet counts

 -  Independent / community living

 -  Written informed consent obtained

 -  Performance level ECOG 2 or better

 Inclusion Criteria: Non-anemic adult control (non-elderly), for blood and urine samples
 only

 -  Age 20 to 64

 -  Hemoglobin ≥ 13 g/dL (men) or ≥ 12 g/dL (women) within at least 90 days of enrollment
 into the study

 -  Normal white blood cell and platelet counts

 -  Independent / community living

 -  Written informed consent obtained

 -  Performance level ECOG 2 or better

 -  Will be recruited by the following age strata: 20 to < 35; 35 to < 50; 50 to < 65.

 INCLUSION CRITERIA: Non-anemic adult control (non-elderly), with bone marrow biopsy

 -  Age 20 to 35

 -  Hemoglobin ≥ 13 g/dL (men) or ≥ 12 g/dL (women)

 EXCLUSION CRITERIA: For all groups

 -  Substance abuse or mental health or other problems that would make compliance with the
 protocol unlikely

 -  Predicted mortality in less than 3 months, based on co-morbidities

 -  Known diagnosis of bone marrow disorder such as

 -  Leukemia

 -  Metastatic malignancy with bone marrow involvement

 -  Myelodysplastic syndrome

 -  Monoclonal gammopathy of undetermined significance (MGUS)

 -  On any erythropoiesis-stimulating agent in the prior 3 months

 -  Having received any red blood cell transfusion in the prior 3 months

 -  End stage renal disease as defined by the need for ongoing hemo or peritoneal dialysis

 -  Endstage liver disease as defined by the patient¡-s providers in the medical record

 -  A medical condition which would make participation risky

 -  On any other study requiring ongoing blood or marrow donation which would make
 additional blood or marrow collection risky to the subject

 EXCLUSION CRITERIA: Additional, for healthy controls:

 -  History of active malignancy (except non-melanoma skin cancer), or radiation or
 chemotherapy for treatment of malignancy within the past 24 months

 -  HIV positivity

 -  Hepatitis B or Hepatitis C positivity

 -  Autoimmune disease (including lupus, RA, IBD)

 -  Known hematologic disorder