Finding the Answer to Unexplained Anemia in Older People

Called The Partnership for Anemia: Clinical and Translational Trials in the Elderly (PACTTE), the consortium received a six-year, $16 million grant from the National Institute on Aging to conduct clinical trials and translational studies, with the goal of developing better treatments for unexplained anemia. The consortium comprises physicians and researchers from Duke University, University of Chicago, Stanford University, University of California in Los Angeles, Case Western University, Johns Hopkins University, Howard University, and the University of Utah.

A study of this size and scope is long overdue, according to Josef T. Prchal, M.D., a U of U hematologist and professor of internal medicine, pathology, and genetics who chairs the consortium’s Translational Committee. “The lack of information hematologists and geriatricians have about the underlying causes of unexplained anemia has been a major barrier for testing treatment strategies,” said Prchal, also a member of the PACTTE steering committee. “Through the PACTTE consortium, we expect to make major progress in understanding and treating this condition, which affects a sizable number of people age 65 and older.”

Anemia, a condition in which the body lacks healthy red blood cells to carry oxygen to tissues, affects about 11 percent of adults older than 65, according to the U.S. Centers for Disease Control and Prevention’s Third National Health and Nutrition Examination Survey. The incidence rises to 20 percent of elderly who are older than 85, and live independently, and approaches 50 percent for those who are hospitalized or institutionalized. Two-thirds of anemia cases can be attributed to nutritional deficiencies or an underlying medical condition, such as kidney disease. But little research has focused on unexplained anemia in the remaining one-third of cases in the elderly.

People with anemia often feel tired, and the condition has been associated with increased mortality, hospitalization, higher incidence and more severe cardiovascular disease, cognitive impairment, decreased physical function, and an increased risk of falls and fractures.

Neeraj Agarwal, M.D., the Utah clinical site principal investigator on the study, said unlocking the mysteries of unexplained anemia of the elderly will require learning about the disease at its most elemental level. “We hope to unravel the molecular mechanisms underlying this disease,” said Agarwal, a hematologist, geriatrician, and U of U assistant professor of internal medicine.

The consortium plans to create a network of centers comprising the nation’s most recognized experts in anemia and gerontology and who have demonstrated success at recruiting patients to trials. The group’s first trial will look at currently available information, and test an agent already approved for use in anemia: erythropoiesis-stimulating agents (ESAs).

ESAs routinely are used in anemia associated with chronic kidney disease, cancer, and other illnesses, but not in unexplained anemia. Studies have proven the treatment is effective in improving cognitive and heart function in some populations. But few studies have been done regarding ESA treatments in older adults, and those undertaken often are discontinued because of difficulty enrolling older patients in clinical trials. The treatment also has risks. ESA has been linked to hypertension and increased risk of blood clotting.

Data gathered from the PACTTE and other clinical trials will help the consortium develop diagnostic criteria and treatment guidelines and form the basis for future studies designed to address anemia treatment in older adults.

The national principal investigator of PACTTE is Harvey J. Cohen, M.D., director of the Center for the Study of Aging at Duke University Medical Center.

Other U of U physicians taking part in PACTTE are: Mark A. Supiano, M.D., a geriatrician, director of the Utah Center on Aging, and professor of internal medicine; and Gordon J. Chelune, Ph.D., professor of neurology.

Supiano, also chief of the Division of Geriatrics, and Chelune are members of the consortium’s Outcomes Committee. Agarwal, in addition to being the Utah principal investigator, serves on the PACTTE steering committee.

For information about the PACTTE study call (801) 581-3707.

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