Anemia
Conditions
Brief 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).
Detailed description
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) .
Interventions
None listed
Sponsors
Stanford University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
Yes
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
Countries
United States
Outcome results
None listed