This week’s CSI:Miami episode had a little bit of immunology involved. Too bad it was a little vague and somewhat incorrect. Here’s what I found wrong with it:
1. Quote: “…will show Rh+ antibodies, which a woman produces when she’s pregnant”
Reality: Rh+ antibodies are only produced when an Rh- mother has an Rh+ child. But, nowadays, the Rh- mother is given Rhogam after she has an Rh+ child so that the Rh+ antibodies are destroyed.
2. Quote: “…if it precipitates, then we’ got her.”
Reality: This is true, my bad. I was thinking agglutination reaction, but that’s only if it is a solid particle. An immunoglobulin test is actually a precipitation reaction. Anti-D testing (Rh+) is an agglutination reaction, but Anti-Anti-D (Rh+ antibodies) is a precipitation.
3. From the Clip: Centrifuge spins for about two seconds (no cutting) and it is done.
Reality: The centrifuge would have to spin so incredibly fast that it would destroy the sample, not to mention that the reaction couldn’t occur that fast. A real sample spins for five minutes at 2,500 RPM.
4. From the Clip: Delko hands Natalia another reagent to test the sample against.
Reality: Unless he knew that the killer, the one that went to Africa, had received that vaccine, then there is no way that he could have just pulled another reagent out and tested it with success.
5. From the Clip: After another two second sping, the precipitation reaction is bubbling. Delko calls it ‘clotting.’
Reality: That’s not a precipitation reaction. A precipitation reaction would have small particles in it, not bubbling. If that kind of reaction happened in your body to a real antigen, you’d die. That looks like baking soda and vinegar or an acid/base reaction.
6. Same clip quote: “…shows specific IgG and IgM antibodies.”
Reality: The reaction would not show IgM antibodies because that would only indicate a present infection. If she had been very recently vaccinated or recently had an infection, then yes, it would show IgM. Most likely, however, it would show IgG. And you wouldn’t be able to do it in a precipitation reaction like that, you’d have to do a latex agglutination. That would be much more sensitive, and COULD show some IgM antibodies.
7. Quote: “…being a CSI, that’s something I do really well.”
Reality: Too bad you couldn’t say the same thing about your acting.
8. Quote: “Blood from the crime scene showed IgG and IgM antibodies.”
Reality: Brilliant! Any sample from anyone (almost) would show IgG and IgM antibodies. You’d have to test for each ONE to say that it was specific.
9. Rant: How did Delko know that she’d been immunized from Dang Fever (Motaba virus perhaps?)

OK, so there’s six errors, not counting my rant, the precipitation/agglutination thing, and her acting. But still, six critical errors in three minutes. Maybe they’re looking for a new technical writer???

This video may be disgusting to some people. In the episode of House “Insensitive”, a girl came into the ER presenting without pain perception. House immediately diagnosed her with CIPA (Congenital insensitivity to pain with Anhidrosis). He found out that it really wasn’t CIPA but actually…..B12 deficiency. Wilson inevitably says something which sparks House’s imagination, and he instantly figures out that it really is B12 even though they ruled that out in the differential diagnosis. They also said that her WBC count was normal (earlier in the episode, here they say it was low with eosinophilia), and giving her NO2 (nitrous oxide) makes her paranoid because of the B12. They really should have done the Shilling test to determine if her B12 deficiency was malabsorption, which was this case, or if it was actually pernicious anemia. They should have also seen oval macrocytes and hypersegmented neutrophils in the WBC differential. Anyways, House figures out that it is actually Diphyllobothrium latum “fish tapeworm”, a 25′ one to be precise, that is causing her B12 deficiency, since this ‘other mouth to feed’ is consuming all of her B12, giving her CIPA-like symptoms. Great tie in to hematology class!
addendum…
After reading more of the notes, I also found that neurological changes, such as this girl has, are only found in B12 deficiency. Also, tingling, numbness, and weakness of the extremities as well as mental disturbances including “Megaloblastic Madness” are all symptoms that can occur before the anemia is present, therefore, she may not have had any WBC signs besides a low WBC and eosinophilia.