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In oral evidence to the Inquiry, Dr Brian McClelland explained that the letter "Testing blood donors for Non-A, Non-B Hepatitis: irrational, perhaps, but inescapable" published in the Lancet was written partly out of extreme frustration at the fact that the appropriate epidemiological studies with donors and recipients had repeatedly not been done.

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In oral evidence to the Inquiry, Dr Brian McClelland agreed with the description of "decision paralysis" in relation to the situation with introduction of surrogate screening and undertaking of the respective study from the early 1980s through to the end of 1988.

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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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An article in Transfusion by Wicks et al highlighted the drawbacks of both ALT and anti-HBc screening, and proposed greater medical education and more restrained blood usage to minimise new post-transfusion NANBH cases.

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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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Dr Brian McClelland stated he would provide data on raised ALT levels in blood donors by Autumn 1986. The SNBTS directors agreed to consider funding

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Dr Forrester appeared sceptical about the introduction of surrogate screening which was reflected in his note on SNBTS Directors' meeting where he commented that there was "no justification for panic measures."

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Dr Forrester asked the Communicable Diseases Surveillance Unit in Glasgow for information on the likely incidence of NANBH in Scotland, the proportion of NANBH attributable to blood transfusion or administration of blood, and how far any proposed test could reduce this proportion.

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A journal article reported an association between anti-HBc and NANBH and that a high percentage of NANBH patients develop chronic hepatitis. It concluded that if surrogate screening could prevent approximately one third of transfusion-associated cases of NANBH, this could represent an annual reduction of 50,000 cases of hepatitis and 2,500 cases of cirrhosis in the US.

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The Statistics Expert Group's Report stated that post-transfusion HCV infections could not be properly estimated before reliable tests were adopted in the early 1990s, and so estimates of the number infected, when based on pre-1990 studies, needed to be treated with great caution.

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The Regional Transfusion Directors' meeting agreed that a study on NANB Hepatitis should not be carried out because of lack of time and resources.

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