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Autoimmune Hemolytic Anemia With Both Cold and Warm Autoantibodies

Neil Jay Nusbaum, MD; Sundeep Khosla, MD
JAMA. 1985;254(9):1175-1176. doi:10.1001/jama.1985.03360090065019.
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To the Editor.—  Shulman and colleagues1 describe a syndrome of autoimmune hemolytic anemia with both warm and cold autoantibodies. We, too, have followed up a patient with this syndrome who was initially seen at 47 years of age with hemolytic anemia, thrombocytopenia, and neutropenia.

Report of a Case.—  The patient demonstrated a direct antiplatelet antibody and a direct antineutrophil antibody. He had a positive direct Coombs' test for IgG and his indirect Coombs' test confirmed the presence of a warm-reacting antibody, but he also had a cold agglutinin titer of 1:16. His antinuclear antibody test results were negative, and he had no evidence of connective tissue disease at the time of the physical examination.The patient's condition improved dramatically on a regimen of high-dose steroids, the dose of which was then tapered. Over two months he maintained a mild compensated hemolysis. As his steroid regimen was reduced below 30 mg/day,


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