Anemia in the Elderly

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