Clinical Problem-Solving: Costly Errors

To the Editor: In the Clinical Problem-Solving case presented by Dr. Duffy (June 1 issue), 1 concerning a patient with hemolytic anemia due to cold agglutinins who later received a diagnosis of large-cell lymphoma, there was a failure to probe for an important pathogenetic link that might have led to more rational and effective therapy. Serum electrophoretic and immunofixation studies in patients with cold-agglutinin anemia and lymphoma usually reveal a monoclonal immunoglobulin of the IgM type, and in rare cases of the IgG or IgA type. 2 Coupled with phenotypic studies of lymphoma tissue (i.e., heavy and light chains and CD5 expression), . . .