Clonal evolution in the population aged 80 years or older. (A) Clonal evolution in subjects from the Health_&_Anemia cohort with multiple samples available (n = 96). (B) Clonal evolution (subject 269). This female subject was born on 1921. In 1999, she displayed normal blood count. In 2003, a first mutational screening was performed with evidence of a mutation in SF3B1 gene with 0.02 VAF. At this time, the subject showed normal hemoglobin (Hb) level (12.1 g/dL), RDW (12), and MCV (87). Since 2003, this subject experienced increasing in RDW and MCV, and in 2007, a mild anemia was observed (10 g/dL). At this time, mutational screening showed increase in SF3B1 VAF (0.24). In 2008, a diagnosis of myelodysplastic syndrome with ring sideroblasts was performed. (C) Clonal evolution (subject 1145). This male subject was born in 1922. In 1999 blood count was normal. In 2003 a first mutational screening revealed a mutation in TET2 gene with 0.02 VAF. At this time, the subject showed a mild anemia (12.7 g/dL), with increased RDW (14.2) and normal MCV (89). In 2007, hemoglobin level decreased to 11.8 g/dL, and mutation analysis showed an increase in TET2 mutation VAF to 0.16. From 2007 to 2012, a further decrease in hemoglobin level, together with an increase in RDW and MCV, was noticed. In 2013, a diagnosis of myelodysplastic syndrome with unilineage dysplasia was made.