anemia in the elderly

Conditions: Anemia

Summary: 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) .

Eligibility criteria:
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