Polite Dissent

Amazing Spider-Man #543 “Back in Black, part 5: An Incident on the Fourth Floor”
J. Michael Straczynski, writer
Ron Garney, penciler

Two issues ago, Peter secretly transfused some of his blood into Aunt May. In this issue, the police have finally discovered that there is an old lady with an unexplained gunshot wound in the hospital and are starting to ask questions. One doctor they talk with has a great deal to say:

Doctor: Been tracking her vitals since she got in. And in the last 48 hours there’s been a change in her blood report.
Doctor: In the last 48 hours her blood count changed and we’ve detected traces of radiation in her system that weren’t there when she arrived. And something the lab can only identify as a variant of spider venom.

Two nit-picks to start off with. First, lab reports (or “blood report” as she calls them) it are not vitals. “Vitals” is short hand for vital signs, and as generally understood the four main vital signs are temperature, heart rate, blood pressure, and respiratory rate. Depending on the circumstances, there can be other vital signs (especially in patients in the ICU) including weight, intake/output, and various cardiac numbers. Every once in a while, a special interest group comes out with a report suggesting an additional “fifth vital sign” that we’re all supposed to track. (“Pain” was the most recent of these suggested new vitals.) Regardless, labs are not vitals, they are labs. Second (and I’m being really nit-picky here), as I mentioned above, no physician or nurse would use the phrase blood report. If they were speaking generally, they’d say “lab report” or “labs,” if they were being more specific, they’d say “blood count” or “CBC” (shorthand for Complete Blood Count) — and she got it right the second time.

Aunt May just received a blood transfusion from Peter. We’d expect to see her hemoglobin and hematocrit (“H&H”) significantly elevated compared to her numbers before the transfusion. It’s not uncommon to see a slight day-to-day variation in the blood count, and various conditions can cause a steady or sudden decline in the H&H, but it would be extremely unusual to see the hemoglobin and hematocrit bump up unexpectedly by a several points.

If I were faced with a patient with an unexpectedly elevated blood count, I would first suspect that the patient might be dehydrated. When someone is dehydrated, their blood components are more concentrated and falsely appear to be elevated. Once they are rehydrated, the blood values will return to normal. If the patient is not dehydrated, I would suspect a lab error and repeat the test. If the second blood test showed the same results, then I’d be truly puzzled.

I would never order a radiation test of the blood — mainly because there is no such thing! I can’t imagine how they discovered Aunt May is radioactive unless someone happened to walk by with a Geiger counter (and apparently they do it regularly because they knew she was not radioactive when she was admitted). I also find it hard to believe that any hospital has a test that can identify spider venom (let alone a variant). Even assuming that such a test existed, why would they choose to run it on Aunt May? Is a rising blood count a symptom of spider envenomation? Remember that lab tests are not run haphazardly; they are run for a specific reason, either to rule something in, or rule something out — I can see no good reason to look for radiation or envenomation in May because her symptoms (a rising blood count) are the opposite of what these conditions would cause.

If I were suspicious that the patient had received a surreptitious transfusion — and it seems the doctor has her suspicions — then there are real world tests that can be performed to look for the blood cells of two different individuals in her blood sample. The test works, just ask former professional bicyclists such as Tyler Hamilton and Alexander Vinokourov who were caught blood doping using such tests.