Well, I’ve not seen it yet, but House has it wrong. On the episode “You Don’t Want To Know” broadcast November 20, 2007, a patient has an unexplained illness that the team is trying to discover. Go figure. The patient was transfused with type AB blood (pos or neg doesn’t matter in this instance). They first thought it was some sort of bacterial contamination (Pseudomonas, which can’t survive refrigerator temperatures). House plays the guinea pig and is transfused with a unit from the same donor (how they would have received more than one unit from the same donor is beyond me. Not impossible, but not probable). He has a febrile reaction to the transfused, so they assume that the bacterial infection is the cause (Yesenia entercolictica is more likely). House dismisses his reaction as just a mild transfusion reaction, someone drugs him, etc, etc. Anyways. It is found out later that the patient is actually type A blood, not type AB. Transfusing him with type AB blood would cause a serious transfusion reaction (DIC, renal failure, etc) as did happen in this patient. BUT then they start explaining blood groups and how they work. Here are a few things they say about the blood grouping and typing and what is wrong with these statements:

• Statement: The patient’s blood was not typed before being transfused
  Truth: FALSE -the blood bank performs typing on all patients before transfusion to ensure that they are receiving the correct type of blood.
• Statement: The patient’s blood is only tested for antibodies
  Truth: FALSE – a type and screen involves typing the blood’s antigens and testing for antibodies, including unexpected antibodies (forward – antigens, and reverse – antibodies). So I guess, YES, he was tested for antibodies, but there would have been a discrepancy in the forward/reverse typing.
  

  Group/Patient	Forward (Antigen)		Reverse (Antibodies)
  	A	B	A1 cells	B cells
  A	+	-	-	+
  B	-	+	+	-
  AB	+	+	-	-
  O	-	-	+	+
  Patient 1	+	+	-	+
  Patient 2	+	-	+	+

  The forward typing tests for the antigens present on the red cells. In a group A individual, the A is positive. The reverse testing tests for antibodies. In a group a individual, group B antibodies are made. A group AB individual has no antibodies, and a group O individual has both A and B antibodies.

  In patient 1 , the patient forward types as a group AB and reverses as group A. This is known as “Acquired B” and can be caused by certain bacteria present in the patient. In patient 2 (Pt2), the patient forward types as group A and reverses as group O. Patient 2 seems to be the likely scenario that is explained in House (if they have their antibodies/antigens mixed up), because the patient has an antibody to a blood group he doesn’t have. If there was a discrepancy, and it was an emergency, then they would have transfused him with type O neg blood (no antigens, so no problems).

  I am unsure that house was talking about when he talks about antibodies and antigens, but he has it wrong. Now, Patient 2 scenario also makes sense if the person were group A2, not A1. Most group A people are group A1. They have both group A1 and A on their RBCs. Group A2 people only have group A on their cells and, if presented with group A1 blood previously, could make anti-A1, thus reacting with the A1 cells and causing an apparent discrepancy in the typing. Retyping with A2 cells would then show a group A2 individual.

• Statement: House talks about his ‘natural antibody type A’ and the one extra ‘type B antibody’ he makes
  Truth: If he made type A antibody, he would be group B (A ab –> B ag). If he made both, he’d be a group O. If he made neither, he’d be group AB. Here, House is likely talking about the Antigens (ag) on the RBCs, not the Antibodies (ab), which makes him likely an acquired B if he reverse typed as group A.

House and his colleagues make some other comments about only testing for antibodies you make, not the type of blood. This is not true. The body could be making the extra antibody because of type A2 blood, not an autoimmune disorder as House explains it away as. Anyways. I am in blood banking this week, so I have blood banking on the brain and this story bothered me. Are the writers getting stupid? I’ve never seen this glaring of an error on House before. A little stretched truth, yes, but no errors. This is more of a CSI level mistake. That’s enough for now.