Reducing salt in food; setting product-specific criteria aiming at a salt intake of 5 g per day.

BACKGROUND/OBJECTIVES: There is an increasing public health concern regarding high salt intake, which is generally between 9 and 12 g per day, and much higher than the 5 g recommended by World Health Organization. Several relevant sectors of the food industry are engaged in salt reduction, but it is a challenge to reduce salt in products without compromising on taste, shelf-life or expense for consumers. The objective was to develop globally applicable salt reduction criteria as guidance for product reformulation. SUBJECTS/METHODS: Two sets of product group-specific sodium criteria were developed to reduce salt levels in foods to help consumers reduce their intake towards an interim intake goal of 6 g/day, and­on the longer term­5 g/day. Data modelling using survey data from the United States, United Kingdom and Netherlands was performed to assess the potential impact on population salt intake of cross-industry food product reformulation towards these criteria. RESULTS: Modelling with 6 and 5 g/day criteria resulted in estimated reductions in population salt intake of 25 and 30% for the three countries, respectively, the latter representing an absolute decrease in the median salt intake of 1.8-2.2 g/day. CONCLUSIONS: The sodium criteria described in this paper can serve as guidance for salt reduction in foods. However, to enable achieving an intake of 5 g/day, salt reduction should not be limited to product reformulation. A multi-stakeholder approach is needed to make consumers aware of the need to reduce their salt intake. Nevertheless, dietary impact modelling shows that product reformulation by food industry has the potential to contribute substantially to salt-intake reduction.

Urological anomalies in anorectal malformations in The Netherlands: effects of screening all patients on long-term outcome.

INTRODUCTION: Urological anomalies are frequently seen in patients with anorectal malformations (ARM) and can result in upper urinary tract deterioration. Whether the current method of screening is valid, adequate and needed for all patients is not clear. We, therefore, evaluated the urological screening methods in our ARM patients for changes in urological treatment, outcome and follow-up. METHODS: The medical records of 331 children born with an ARM in the period 1983-2003 were retrospectively studied. Documentation of diagnosis, screening method, urological anomalies, treatment, complications, follow-up and outcome were measured. RESULTS: The overall incidence of urological anomalies was 52%. The incidence of urological anomalies and urological follow-up time decreased with diminishing complexity of the ARM. Hydronephrosis, vesico-urethral reflux, lower urinary tract dysfunction and urinary incontinence were encountered most. Treatment invasiveness increased with the increase of complexity of an ARM. Lower urinary tract dysfunction needing urological care occurred in 43% in combination with lumbosacral or spinal cord anomalies and in 8% with no abnormalities in the lumbosacral-/spinal region. CONCLUSIONS: Urological anomalies in patients with complex ARM are more severe than in patients with less complex ARM. Ultrasonography of the urinary tract should be performed in all patients. Voiding cysto-urethrography can be reserved for patients with dilated upper urinary tracts, urinary tract infections or lumbosacral and spinal abnormalities. All patients with complex ARM need urodynamic investigations. When using these indications, the screening for urological anomalies in ARM patients can be optimized with long-term follow-up in selected patients.

An unusual cause of syndrome of inappropriate antidiuretic hormone secretion.

A 22-year-old woman was admitted to intensive care with severe hyponatraemia. She suffered from lower abdominal pain, vomiting and irritability since one week. Physical findings showed euvolemia and an altered mental status with severe agitation and slurred speech. Abdominal examination was painful but there were no signs of peritonitis. Laboratory data were compatible with the diagnosis of syndrome of inappropriate secretion of antidiuretic hormone. Since patient was in a premenstrual phase, recently started to take an oral contraceptive and since no abnormalities were seen on an abdominal CT scan, the presentation was considered suggestive of an acute porphyria attack. A urinary sample indicated markedly increased levels of delta-aminolevulinic acid, porphobilinogen and uroporphyrin. A low activity of the porphobilinogen deaminase enzyme confirmed the diagnosis of acute intermittent porphyria. The present case demonstrates the need for a high level of suspicion in order to diagnose this disorder in unexplained syndrome of inappropriate antidiuretic hormone secretion and prevent life-threatening complications.

Co-inheritance of haemoglobin A2' and beta-thalassaemia in cis.

HbA2' is a haematologically silent delta chain variant that elutes in the S-region on high performance liquid chromatography. The major clinical significance of HbA2' is that failure to detect it might lead to failure to recognize beta-thalassaemia minor. Co-inheritance of HbA2' and beta-thalassaemia in cis has been described only once in a family from Suriname. We describe a new case of co-inheritance in cis of HbA2' and beta-thalassaemia in a family from Ghanaian origin with a HbA2' of more than 3%. Molecular investigation revealed the same mutations as in the family from Suriname, suggesting a common origin of both families.

External quality assessment in the measurement of haemoglobin by blood gas analysers in Belgium.

OBJECTIVE: The Belgian national External Quality Assessment Scheme (EQAS) for haematology organized a survey to assess the reliability of haemoglobin (Hb) measurements with the blood gas analysers (BGAs) currently available in Belgian hospitals. MATERIAL AND METHODS: All hospital laboratories received two specimens of fresh EDTA anticoagulated whole blood and were asked to determine the Hb concentration using both the conventional haematology analyser (HA) and all BGAs in the hospital. Ninety-seven hospital laboratories participated in the study and a total of 166 results were reported. The BGAs used (grouped according to technology) were Rapidlab 845, 855, 865 (Bayer 1, n = 41), Rapidlab 1245, 1265, Rapidpoint 405 (Bayer 2, n = 19), GEM Premier 3000 (Instrumentation Laboratory, IL, n = 13), ABL 500 and 600 series (Radiometer 1, n = 13), ABL 700 and 800 series (Radiometer 2, n = 35), Omni C, S5 (Roche 1, n = 7), Omni 3, 6, 9, S2, S4, S6 (Roche 2, n = 21). RESULTS: For the BGAs from Bayer, Radiometer and Roche, interlaboratory variation ranged from 0.6 % to 4.1 %, indicating good precision and close agreement between centres. A significant negative bias observed on the GEM Premier 3000 using the EDTA anticoagulated blood samples did not appear to be present in fresh heparinized whole blood samples. There was no significant difference in imprecision and bias between Hb measurements on BGA situated in and outside the central laboratory.

Idebenone treatment in Friedreich's ataxia: neurological, cardiac, and biochemical monitoring.

The authors report 1-year prospective data on eight patients with Friedreich ataxia. Idebenone did not halt the progression of ataxia. At the end of therapy, cardiac ultrasound demonstrated significant reduction of cardiac hypertrophy in six of eight patients. Cardiac strain and strain rate imaging showed that the reduction of hypertrophy is preceded by an early and linear improvement in cardiac function. Idebenone reduced erythrocyte protoporphyrin IX levels in five of six patients with elevated baseline levels; however, changes did not consistently relate to cardiac improvement.

Persistent polyclonal B-cell lymphocytosis.

We present a case of persistent polyclonal B-cell lymphocytosis (PPBL). This syndrome is characterized by a persistent lymphocytosis with circulating atypical binucleated lymphocytes. The patient had serological evidence of a previous EBV infection, had raised polyclonal serum IgM levels and was a heavy smoker. No malignancy was detected.

In vitro activity of gemifloxacin compared with other antimicrobial agents against recent clinical isolates of streptococci.

This study investigated the in vitro activity of gemifloxacin (SB-265805) against 50 recent clinical isolates of Streptococcus pyogenes, Streptococcus agalactiae and viridans streptococci using the microdilution method. This activity was compared with that of the quinolone agents ofloxacin, ciprofloxacin, levofloxacin, trovafloxacin and grepafloxacin, and with that of penicillin, ampicillin, clarithromycin and azithromycin. Gemifloxacin was significantly more potent than the other quinolones tested. Its potency was equal to that of penicillin for S. agalactiae, and superior to that of penicillin for viridans streptococci. The MIC(50) of gemifloxacin for S. pyogenes (0.015 mg/L) was equal to that of penicillin, with an MIC(90) of 0.03 mg/L. Gemifloxacin was also active against isolates of S. agalactiae (MIC = 0.03-0.06 mg/L) and S. pyogenes (MIC = 0.03- 0.06 mg/L) with reduced susceptibility to ofloxacin (MIC = 4-8 mg/L) and grepafloxacin (MIC = 4 mg/L). These preliminary observations indicate that gemifloxacin is a promising antimicrobial agent for clinical use.

The presence of transcription factors in chicken albumin, yolk and blastoderm.

Embryonic development is determined by preset intrinsic programs and extrinsic signals. To explore the possibility that transcription factors are present at the onset of development, preparations of yolk, albumin, and blastoderm from unfertilized and fertilized white Leghorn chicken eggs were screened by a panel of 16 transcription factor antibodies with Western blot techniques. Yolk was positive for 13 transcription factors, whereas blastoderm was positive for 10, and albumin was positive for 5. In yolk, several transcription factors, GATA-2, E2F-1, MyoD, and TFIID, were developmentally regulated. These results indicate that intracellular yolk and extracellular albumin contain transcription factors which presumably influence early chick embryonic development from prefertilization to the late blastoderm stage. Thus, the utility of preset maternal transcription factors within yolk and albumin complement maternally derived mRNA to determine the early development of the zygote.

The presence of transcription factors in fetal bovine sera.

Three sources of fetal bovine serum (FBS) were fractionated by ammonium sulfate precipitation and by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), transferred to Immobilon-P membranes, immunoblotted with a panel of transcription factor antibodies, and detected by enhanced chemiluminescence. Nine transcription factors were detected--ATF-2, SRE-ZBP, GATA-2, TFIID, Ets-1/Ets-2, E2F-1, Oct-2, p53, and AP-2; four transcription factors were not detected--Myo D, CREB, Sp2, and Wilms' tumor. The results indicated the presence of varying amounts of several transcription factors in three commercial sources and may represent heretofore unrecognized factors influencing cell culture.

CD44H localization in primary open-angle glaucoma.

PURPOSE: Primary open-angle glaucoma (POAG) is associated with a decreased content of hyaluronan in the trabecular meshwork and in the juxtacanalicular connective tissue. In this study, the authors examined selected regions of the anterior segment to localize and determine the content of CD44H, a transmembrane multifunctional glycoprotein and the principal receptor of hyaluronan. METHODS: Sections of ethanol-fixed anterior segments of six POAG and six normal postmortem eyes were analyzed by immunostaining with and without the nonionic detergent Triton X-100, using the CD44H monoclonal antibody, and the avidin/biotin complex. They were visualized by Vector VIP substrate and were quantitated by computer-aided color image analysis. RESULTS: CD44H was expressed in all regions. Statistically significant decreased content of CD44H was observed in the POAG regions compared with normal regions--ciliary muscle (P < 0.001), ciliary stroma (P < 0.001), anterior iris (P < 0.05), iris root (P < 0.05), and trabecular meshwork (P < 0.05)--and in a subgroup of nonlaser POAG juxtacanalicular connective tissue (P < 0.05) and trabecular meshwork (P < 0.01). In sections treated with Triton X-100 a further increase in immunostaining was observed in normal eyes. As evidenced by scattergram plots of the ciliary body stroma region of the change in the optical density of CD44H between pretreatment with Triton X-100 and without Triton X-100 (y axis) versus the optical density of CD44H without Triton X-100 (x axis), individual cases of POAG were separated from normals. CONCLUSIONS: These results indicate that CD44H may represent a marker of POAG and an etiologic factor in the POAG disease process.

Pathological changes in exposed neural tissue of fetal delayed splotch (Spd) mice.

If meningomyelocele is indeed a progressive intrauterine process, then early delivery or possibly intrauterine repair of meningomyelocele becomes an issue. Utilizing the delayed splotch (Spd) mouse, a genetically transmitted neural tube defect model, we looked for evidence of abnormalities of neural tissue exposed to amniotic fluid. Affected embryonic and fetal mice were examined with the light microscope, and also with the transmission and scanning electron microscope. Neuronal development and programmed cell death paralleled normal fetal development. No evidence of inflammation on or within the exposed neural tissue was observed. Because the vascular supply to the alar and basilar plate are different, vascular development was also examined and no difference could be found. In conclusion, we found no evidence of deterioration of the exposed neural tube during the gestational period of a mouse, which suggests that exposure of unneurulated spinal cord to amniotic fluid is not a risk factor to the fetus with a neural tube defect.

Evaluation of the Abbott Cell Dyn 4000 automated fluorescent reticulocyte measurements: comparison with manual, FACScan and Sysmex R1000 methods.

The Abbott Cell Dyn 4000 (CD4000) is the first haematology analyser in which fully-automated reticulocyte measurements can be routinely determined by fluorescence as part of the full blood count. This communication reports the first evaluation of this method which was undertaken by three independent reference laboratories in Belgium, Germany and Italy. A total of 695 different samples was entered into the study which was designed to compare CD4000 reticulocyte information (enumeration and qualitative maturational data) with results determined in parallel with the existing manual (supravital staining) reference procedure, and two semi-automated fluorescent assays (Becton Dickinson FACScan and Sysmex R1000 instruments). These studies revealed good agreement between the CD4000 and the manual procedure, with no inter-method bias. Comparison of CD4000 and FACScan reticulocyte measurements, however, indicated a distinct tendency for the FACScan to give higher reticulocyte estimates than the CD4000. Finally, the comparison of the CD4000 with the Sysmex R1000 showed excellent agreement in the range 0-6% reticulocytes, although there was some inter-method bias in the higher range (> 15%). Analysis of agreement levels between the methods using specific 'clinical decision points' confirmed the tendency for overestimation by the FACScan, in that 58% of the samples with a reticulocytopenia of < 0.5% as defined by the CD4000 gave FACScan results within the normal range (0.5-1.8%). In contrast, there was absolute agreement between the CD4000 and the Sysmex R1000 for all reticulocytopenias. Comparison (195 samples) of instrument fluorescent reticulocyte maturation profiles demonstrated an exponential relationship (r = 0.78) between CD4000 IRF and R1000 HFR (highly fluorescent reticulocyte fraction) values. The suggestion that the CD4000 IRF values includes some of the MFR as well the HFR reticulocyte fraction was confirmed as the correlation between the CD4000 IRF and the Sysmex R1000 MFR plus HFR percentages was linear (r = 0.82). This study confirms a high performance level for the CD4000 automated fluorescent reticulocyte method.

Ultrastructural studies of primary congenital glaucoma in rabbits.

BACKGROUND: The cause of congenital glaucoma is unknown. METHODS: To determine whether the site of impaired aqueous outflow is the entrance to the trabecular meshwork (TM), within the TM, the aqueous drainage plexus, or a combination thereof, the process of TM development was examined by scanning and transmission electron microscopy on postnatal day 3 and weeks 1, 2, 3, 4, and 6 in New Zealand rabbits homozygous for the buphthalmic (bu/bu) gene compared with age-matched controls. RESULTS: Openings to the entrance of the TM in congenital glaucoma were observed, and there was no evidence of an endothelial membrane occluding aqueous flow to the TM. The morphology of the congenital glaucoma TM was abnormal in all bu/bu rabbits by 2 weeks and was characterized by a smaller entrance to the TM at the iris base, smaller intertrabecular openings within and between the trabecular lamellae, and at 6 weeks, iris pillars with extensive lateral extensions in the angle recess. Most intertrabecular spaces were open, however, the inner intertrabecular spaces adjacent to the aqueous plexus were compressed. CONCLUSION: These results suggest the development of congenital glaucoma, which involves a mutation in an autosomal recessive gene and leads to loss of function of a gene(s) required for the differentiation of the TM.

Glycosaminoglycan stratification of the juxtacanalicular tissue in normal and primary open-angle glaucoma.

PURPOSE: The juxtacanalicular tissue (JCT) is the probable site of aqueous outflow resistance in normal eyes and of the increased resistance in primary open-angle glaucoma eyes (POAG). The purpose of this histochemical study was to determine the glycosaminoglycan (GAG) composition and stratification in the JCT of POAG and age-matched normal eyes. METHODS: Five eyes from four normal donors and five eyes from four POAG donors (69 to 80 years of age) were analyzed. Using methods that histochemically preserve GAGs, GAG-degrading enzymes, Alcian blue staining, and real color discrimination to exclude pigment, nuclear staining and unstained areas, the type and amount of GAGs were estimated by compute-raided charge-coupled device color video image analysis. To examine GAG stratification, the JCT was segmented into three regions-anterior, middle, and posterior-to examine regional differences in GAG composition; each region was further divided into four 2-microns layers, from layer 1, adjacent to and including the endothelium of Schlemm's canal, to layer 4, to the first trabecular lamellae. RESULTS: The normal GAG JCT profile was as follows: hyaluronic acid (HA), 7.78 +/- 1.23 femtograms (fg)/micron2; chondroitin sulfates (CS), 8.18 +/- 0.82 fg/micron2; dermatan sulfate, 0.29 +/- 0.18 fg/micron2; the total, 18.73 +/- 0.68 fg/micron2. In contrast, the POAG GAG JCT profile was as follows: HA 0.57 +/- 0.31 fg/micron2 (P < 0.00001), a 93% decrease; CS 13.49 +/- 0.74 fg/micron2 (P < 0.0001), a 83% increase; dermatan sulfate, 0.90 +/- 0.53 fg/micron2; and the total, 17.31 +/- 0.95 fg/micron2, an 8.2% decrease. The HA was depleted in all layers of all regions of POAG JCT. CONCLUSIONS: Results indicate that the normal JCT is stratified, with HA as the predominant GAG in layers 1 and 2. The POAG JCT is depleted of HA and has an accumulation of CS, which may increase outflow resistance and, consequently, increase intraocular pressure in patients with POAG.

Glycosaminoglycans of the human trabecular meshwork in primary open-angle glaucoma.

PURPOSE: Glycosaminoglycans (GAGs) contribute to the filtration barrier of aqueous outflow through the trabecular meshwork (TM). The purpose of this biochemical study was to identify the type and amount of GAGs in normal and in primary open-angle glaucoma (POAG) TM and adjacent anterior segment structures. METHODS: The GAGs of 21 masked individual normal and POAG human TMs, as well as iris, ciliary body, and anterior sclera, were isolated biochemically, identified by selective GAG-degrading enzymes, and quantitated by computer-enhanced densitometry. RESULTS: In 10 normal TMs (8 donors, 65 to 83 years of age), the GAG profile was: hyaluronic acid (0.77 +/- 0.26 ng/microgram dry-defatted weight +/- SEM); chondroitin 4(6-) sulfates and dermatan sulfate, collectively referred to as chondroitin sulfates (1.90 +/- 0.13 ng); keratan sulfates (0.33 +/- 0.06 ng); heparitin sulfates (2.02 +/- 0.52 ng); GAG enzyme-resistant material (0.02 +/- 0.01 ng); and total GAGs (5.05 +/- 0.70 ng). In 10 POAG TMs (6 donors, 67 to 88 years of age), the GAG profile was: hyaluronic acid (0.18 +/- 0.11 ng; P < 0.02, a 77% decrease; 6 of 10 TMs contained no detectable hyaluronic acid); chondroitin sulfates (2.39 +/- 0.31 ng); keratan sulfates (0.21 +/- 0.06 ng); heparitin sulfates (1.36 +/- 0.43 ng); GAG enzyme-resistant material (0.08 +/- 0.01 ng; P < 0.02); and total GAGs (4.09 +/- 0.33 ng; statistically insignificant). In the POAG iris, hyaluronic acid content was less (82% decrease, P < 0.02), and the chondroitin sulfates content was higher (72% increase, P < 0.02). Similarly, the POAG ciliary body and anterior sclera contained less hyaluronic acid and more chondroitin sulfates. The GAG profile of a "glaucoma suspect" donor specimen was similar to that of the POAG donor specimen. CONCLUSIONS: The data provide the first quantitative biochemical profiles of GAGs of individual normal and POAG TM, and we suggest that a depletion of hyaluronic acid and the accumulation of chondroitin sulfates may increase aqueous outflow resistance in the POAG TM:

Reduced glutathione for the treatment of anemia during hemodialysis: a preliminary communication.

In 4 chronic hemodialysis patients we have tested whether the administration of reduced glutathione (GSH; Glutamed, Boehringer Mannheim Italia; 1,200 mg i.v.) at the end of each hemodialytic session during 90 days could minimize oxidative damage to the red blood cells (RBC) and reduce the recombinant human erythropoietin requirements. Treatment with GSH was followed by an increase in RBC GSH content (n = 3), a normalization of the ascorbine cyanide test (n = 4), an increase in RBC survival (n = 3), and a reduction in 2 patients of the erythropoietin need (41 and 26%, respectively, after 3 months of therapy). When the GSH supplements were terminated, we noticed after 3 months a re-establishment of the baseline values. On the other hand, malonyldialdehyde, RBC deformability, and RBC splenic pool were abnormal before and remain abnormal during the test period. Since no adverse reactions were noticed, these findings seem to indicate the GSH could ameliorate the intraerythrocytic oxidative defense and could be as useful drug in the treatment of anemia in patients affected by chronic renal failure.

Quality of washed salvaged red blood cells during total hip replacement: a comparison between the use of heparin and citrate as anticoagulants.

A randomized, prospective study comparing heparin with citrate (ACD) as anticoagulant during red blood cell saving was performed in 10 ASA grade I-II patients undergoing primary total hip replacement. Blood samples were taken before and after surgery and at several steps during cell saving. In the heparin group, salvaged red cells showed normal values, with the exception of decreased filtrability and moderate hemolysis. More differences in red cell quality were found in the ACD group. Mean corpuscular volume was higher (110 vs 95 x 10(-12) mL), red cell distribution was increased (17% vs 13%), osmotic resistance was lower (0.54 vs 0.43 g NaCl/L at 50% hemolysis), antioxidative reserve capacity was lower (1.9 vs 4.6 U glutathione reductase per gram of hemoglobin) and there was more hemolysis (15% vs 11%). Despite the small volume of autologous blood retransfused (388 +/- 92 mL), the differences in vitro produced significantly higher free hemoglobin levels in the patients' plasma at the end of the operation (58 vs 23 mg/dL). We conclude that heparin is preferable to citrate as an anticoagulant during autotransfusion with cell washing and immediate retransfusion.

Storage of saline-adenine-glucose-mannitol suspended red cells in diethylhexyl phtalate and butyryl-n-trihexyl-citrate plasticized polyvinyl chloride containers. An in vitro comparative study.

Units of whole blood collected into butyryl-n-trihexyl-citrate (BTHC) and diethylhexyl phtalate (DEHP) plasticized polyvinylchloride (PVC) blood storage containers and processed by means of an 'Optipress', which allows automated removal of the buffy coat, were compared. Units collected into standard PVC containers processed by the traditional method (no buffy coat removal) were used as a control group. The red cell concentrates were suspended in saline-adenine-glucose-mannitol (SAGM) and stored 42 days at 2-6 degrees C. Comparison of the buffy coat depleted red cell concentrates showed that red cell energy and oxygen delivery capacity, as evidenced by ATP and 2,3-DPG values, were slightly better preserved in the BTHC plasticized container, compared to the DEHP container. The red cell membrane, however, was slightly less well preserved, (the hemolysis at day 42 with BTHC ww 0.39%; with DEHP, 0.20%) in this container. The higher ATP levels might lead to a better in vivo recovery of stored red cells. In vivo studies comparing both plastic containers, therefore are indicated in order to determine if these differences have practical significance. A longer holding time of the whole blood at room temperature before processing reduced the hemolysis (42 days stored RCC as 0.26%). Slightly more fibrinopeptide A (FPA) generation and marginally lower pH and 2,3-DPG values were observed in this situation. This finding suggests an effect of higher plasticizer levels on the red cell membrane.

Serum erythropoietin levels in elderly inpatients with anemia of chronic disorders and iron deficiency anemia.

OBJECTIVE: To analyze the relationship between serum erythropoietin levels and hemoglobin levels in elderly patients with anemia of chronic disorders related to cancer or acute infection when compared with anemic patients with iron deficiency. DESIGN: Prospective survey with comparison groups. SETTING: Tertiary care center. PATIENTS: An elderly group aged 70 and above (mean 84, range 70-96) was divided into subgroups of 45 with anemia of chronic disorders (23 with cancer and 22 with acute infection), 24 with iron-deficiency anemia, and 27 with no anemia. Thirty non-anemic younger adults were also studied. MEASUREMENTS: Serum erythropoietin (radioimmunoassay), complete blood count, serum iron, B12, folate and ferritin, liver and kidney function tests, blood gas analyses, and bacteriological and radiological tests. RESULTS: The serum erythropoietin levels were significantly lower in the elderly non-anemic hospitalized group than in the healthy younger group. A significant negative relationship between the log serum erythropoietin and hemoglobin levels was found in patients with iron deficiency, but not in the other groups. For any given hemoglobin level, the response of erythropoietin was significantly higher in anemic patients with iron deficiency when compared with the neoplastic and infectious group. CONCLUSION: Erythropoietin response to anemia is blunted in elderly patients with anemia of chronic disorders related to cancer or acute infection. Erythropoietin level is lower in non-anemic elderly inpatients than in healthy younger persons.