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September 6, 1985

Autoimmune Hemolytic Anemia With Both Cold and Warm Autoantibodies-Reply

Author Affiliations

Los Angeles County-University of Southern California Medical Center
City of Hope Medical Center Duarte, Calif

JAMA. 1985;254(9):1176. doi:10.1001/jama.1985.03360090065020

In Reply.—  The serological features that characterize patients with combined cold- and warm-antibody autoimmune hemolytic anemia are the finding of both IgG and C3d on their red blood cells and the presence in their serum of both IgG warm autoantibodies and high-thermal-amplitude cold autohemagglutinins.1 High-thermal-amplitude cold autohemagglutinins are reactive over a broad temperature range from 0 °C to 30 °C and higher.Nusbaum and Khosla report the condition of a patient whom they believe had combined cold- and warm-antibody autoimmune hemolytic anemia, similar to the patients reported by us in The Journal. Unfortunately, their case report failed to mention important serological data necessary to substantiate their claim. Neither the results of their patient's direct antiglobulin test with anticomplement reagents nor the thermal amplitude of their patient's serum cold agglutinin were reported. Without this information, it is impossible to ascertain whether their patient had combined cold- and warm-antibody autoimmune hemolytic