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Dr James expressed a willingness to collaborate with the Working Party on providing samples from their earlier study while noting he and his colleagues wished to avoid defrosting and refreezing their stored sera on too many occasions.

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Dr Gunson stated in a letter to Dr Keith Gibson that unless they were able to obtain data relating to the situation within the UK, they may be placed in the position of taking up a test, for medico-legal considerations if nothing else, developed abroad where the incidence or characteristics of the illness differs from that in the UK and such a decision could cost the NHS millions each year.

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Dr Gibson of the MRC informed Dr Gunson that many of the samples from the previous MRC study had been lost as a result of power failures, an audit of what was left would be carried.

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Professor Zuckerman informed Dr Gibson that a duplicate set of samples had been disposed of.

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Dr Gunson told the Working Party on Transfusion Associated Hepatitis that many of the samples from his previous MRC study had been lost due to a power failure. The Working Party acknowledged that this ruled out the chance of updating the testing of samples from that study with modern diagnostic assays.

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The Working Party on Transfusion Associated Hepatitis noted that no source of funding had been found to date for Dr Brian McClelland's proposed study.

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The Working Party on Transfusion Associated Hepatitis discussed the possibility of seeking funding from the MRC for a joint study involving Edinburgh and the North London Blood Transfusion Centre. Dr John Barbara planned to speak to the Director and submit a draft proposal.

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The Working Party on Transfusion Associated Hepatitis discussed potential requests to Dr James of the Freeman Hospital for access to samples from his prospective study of 248 patients who had undergone cardiac surgery.

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Dr James and his colleagues published the results of a study on post-transfusion hepatitis after cardiac surgery which suggested that NANBH after blood transfusion "from a largely British blood donor group probably leads to clinically significant chronic liver disease very rarely indeed."

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Dr Gunson stated in his court evidence that he had failed to secure a study of donor recipients around 1983, he said, "I was trying to generate it [data] and seemed to be blocked at every stage."

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Dr Gunson was asked in his court evidence if all the material showed that the introduction of ALT screening would have a beneficial effect if one looked at the concept of minimal risk for the recipient, if the the material was to that effect? Dr Gunson responded, "yes, it would reduce the risk to the recipient."

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An article published in the Annals of Internal Medicine considered the role of anti-HBc as a surrogate, suggesting that the incidence of NANBH might have been reduced by about one third through anti-HBc screening.

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In a letter to The Lancet, Dr Gillon and colleagues called for a study of acute post-transfusion NANB Hepatitis in the UK and stated that surrogate screening was not justified at the time.

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Lord Penrose noted that the study on NANBH in the West of Scotland neither provided a basis on which the prevalence of post-transfusion NANB Hepatitis could, or should, have been drawn, nor indicated the potential value of ALT surrogate testing, or a basis for assessing that value.

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Dr Dow concluded in his PhD thesis on Non-A, Non-B Hepatitis in West Scotland that transfusion associated NANBH was very rare, an average of 3 reported cases were reported annually.

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Dr Dow stated that he thought surrogate testing would have been likely to reduce the incidence of post-transfusion NANBH in Scotland by 70 percent.

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Dr Alter and Dr Dienstag stated in an article on Non-A, Non-B Hepatitis that "the accumulating data that chronic NANB hepatitis leads to cirrhosis in 10 to 20% of cases has served as compelling evidence for the need to rely on indirect assays as an interim measure until such time as specific NANB hepatitis assays are developed."

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In a publication Dr Alter and Dr Leonard Seeff made reference to a study conducted in Germany, which measured the impact of adding anti-HBc testing to the screening of a population already tested for ALT. It showed that recipients of anti-HBc positive blood had a five-fold greater risk of developing post-transfusion hepatitis than recipients of blood testing negative.

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Dr Cash asked Dr Gerald Sandler the outcome of the FDA's deliberations and whether the American Red Cross had decided to introduce routine anti-HBc testing of donations.

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Dr Gerald Sandler informed Dr Cash that the American Red Cross had not changed its approach to donor testing but would review whether to introduce anti-HBc/ALT donor testing imminently.

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