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Figure 1. A 61-year-old roads inspector from Illinois presented in 1992 with hemolytic anemia and acrocyanosis and was found to have cold-agglutinin syndrome. He was treated with plasmapheresis, prednisone, and chlorambucil and then followed without therapy for two years. He continued to work, which involved spending the majority of time outdoors. The patient's cold-agglutinin titer exceeded 1:524,288, with a thermal maximum (the temperature at which agglutination occurs in vitro) of 37°C. The severity of the hemolysis, reflected by the lactate dehydrogenase concentration, was related to the ambient temperature, as illustrated. He is currently well and asymptomatic.
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