Mechanisms Accounting for Unexplained Anemia in the Elderly

February 17, 2024 updated by: National Institute on Aging (NIA)

Assessing Mechanisms Accounting for Unexplained Anemia in the Elderly

Background:

- Anemia occurs commonly and is associated with poor outcomes in the elderly. In about a third of anemia cases in older people (over age 65), the cause of anemia is unexplained. Anemia in older adults may be caused by the bone marrow's inability to produce red blood cells fast enough to replace older red blood cells that have died. Researchers want to look at unexplained anemia by studying the life span of red blood cells in younger adults and older adults. To do so, a vitamin called Biotin will be used as a marker on the red blood cells.

Objectives:

- To investigate possible causes of unexplained anemia in older people.

Eligibility:

  • Individuals in the following groups:
  • Men and women between 18 and 50 years of age who do not have anemia
  • Men and women at least 70 years of age who do not have anemia.
  • Men and women at least 70 years of age who have iron-deficiency anemia.
  • Men and women at least 70 years of age who have anemia with no known cause.

Design:

  • Participants will be screened with a physical exam and medical history. Blood and urine samples will be collected.
  • Participants will have an overnight stay for the first study visit. They will provide a blood sample to which Biotin will be added. The blood sample with Biotin will then be returned to the participant. Twenty-four hours later, another blood sample will be collected.
  • Participants will have up to 14 additional study visits. At each visit, blood samples will be collected to measure the amount of Biotin remaining in the blood.
  • Participants may also provide a separate blood sample for genetic testing. These tests may provide more information about genetic causes of unexplained anemia.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Anemia occurs commonly and is associated with adverse outcomes in the elderly. In approximately one third of anemia cases in patients over the age of 65 years, the cause of anemia is not readily apparent (unexplained anemia or UA). Of the various causes of anemia in young adults, overt hemolysis (either acute or chronic) is very uncommon. However, we speculate that older persons tend to develop a low grade hemolytic process which significantly reduces RBC survival, and when this is not adequately countered by increased bone marrow RBC production, anemia (UA) is the consequence. This hypothesis is supported by a few clinical observations. For example, red cells in patients with UA are generally not small and when the peripheral blood smear is examined microscopically, anisocytosis (varying cell size) is observed, as is typical in patients with hemolytic anemia. Similarly, UA is frequently associated with an elevated red cell distribution width (RDW) on electronic measurement. Furthermore, serum erythropoietin levels gradually rise with advancing age (1), and this would be consistent either with a smoldering hemolytic process or a decreased responsiveness to erythropoietin. To address the hypothesis that UA is due, at least in part, to shortened RBC survival, we propose to directly measure red blood cell survival and to correlate this with aspects of red blood cell physiology that may increase susceptibility to the hemolytic process.

Study Type

Interventional

Enrollment (Actual)

58

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Maryland
      • Baltimore, Maryland, United States, 21224
        • National Institute of Aging, Clinical Research Unit

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

  • INCLUSION CRITERIA:
  • Ambulatory, community dweller
  • Age greater than or equal to 70 years or older or between the ages of 18 and 50 years.
  • Able to understand English
  • Able to complete study questionnaires as determined by the investigator
  • Evidence for recent (within 1 year) clinical evaluation for blood loss directed by primary care physician or consultant in subjects referred with microcytic anemia or with referring laboratories indicative of iron deficiency. Furthermore, subjects found to have microcytic anemia will be eligible but will be referred to their primary doctor for evaluation of blood loss.
  • Provide informed consent

EXCLUSION CRITERIA:

  • Hemoglobin (Hb) less than 9 g/dL during screening
  • History of red blood cell transfusion withinthe 3 month period prior to accrual to this study, or evidence for active bleeding as ascertained by medical history (e.g., persistent melena, hematuria or dysfunctional uterine bleeding).
  • Patients for whom oral iron supplementation has been prescribed within the past two months. (Patients on a stable dose of oral iron for more than two months may be eligible).
  • ALT or AST more than 3 times upper normal limitation of the time of screening
  • B12 or folate deficiencies during screening period
  • Estimated GFR less than 30 ml/min/1.73m(2)during screening period (by the 4-variable Modification of Diet in Renal Disease [MDRD] equation).
  • Receiving hemodialysis or peritoneal dialysis for renal failure, or history of kidney transplant
  • Use of exogenous erythropoietin during the past 3 months
  • Any major surgery requiring general anesthesia within the past 3 months
  • Treatment with chemotherapy or radiotherapy in the past 12 months
  • Current diagnosis of active cancer, other than non-melanoma skin cancer and, stable prostate cancer
  • History of blood disorders including thalassemia, sickle cell disease or myelodysplasia
  • Current severe (NYHA Class III - IV) congestive heart failure or advanced chronic obstructive pulmonary disease
  • Positive serum monoclonal protein and immunofixation
  • Women who are pregnant or women planning to get pregnant during the duration of the study or those with a positive pregnancy test during screening
  • Active infection requiring antibiotic treatment or HIV, Hepatitis B or C
  • History of overt chronic inflammation, active Crohn s disease, rheumatoid arthritis, or diabetes(HbA1C greater than 7),
  • Known hemolytic anemia
  • History of prosthetic heart valve
  • History of participation in biotinylation studies or handling biotinylated reagent products.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Non-Randomized
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Group 1
Age 70 and older with unexplained anemia
Drug: Biotin RBC survival
Active Comparator: Group 2
Age 70 and older with iron deficient anemia
Drug: Biotin RBC survival
Active Comparator: Group 3
Age 70 and older without anemia
Drug: Biotin RBC survival
Active Comparator: Group 4
Age 18 - 50 without anemia
Drug: Biotin RBC survival

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Measurement of red blood cell survival
Directly measure red blood cell survival and to correlate this with aspects of red blood cell physiology that may increase susceptibilty to the hemolytic process

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National Institute on Aging (NIA)

Investigators

  • Principal Investigator: Josephine M Egan, M.D., National Institute on Aging (NIA)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 29, 2012

Primary Completion (Actual)

July 30, 2015

Study Completion (Actual)

July 30, 2015

Study Registration Dates

First Submitted

April 5, 2012

First Submitted That Met QC Criteria

April 5, 2012

First Posted (Estimated)

April 6, 2012

Study Record Updates

Last Update Posted (Actual)

February 20, 2024

Last Update Submitted That Met QC Criteria

February 17, 2024

Last Verified

December 7, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 999912109
  • 12-AG-N109

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

.The NIA IRP is discussing the plan to make IPD available. A final decision has not been made.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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