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Dr Contreras expressed further concerns in her letter to Dr Rotblat saying that inclusion of ALT testing information on commercial products may lead to these products considered superior against those not ALT tested, while there is no evidence for any difference.

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Dr Forrester suggested that the development to state that the donations had been tested for ALT commercial companies, could lead haemophilia clinicians and SNBTS directors to put pressure on the SHHD to agree to the introduction of surrogate screening.

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Dr Fraser expressed disappointment in a response to Professor Cash, particularly in light of his understanding that it had been agreed at the 10 June 1987 SNBTS Directors' meeting that there was "a need for synchrony with England and Wales."

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Professor Cash stated that the SNBTS did not wish and currently had no intention of introducing NANBH surrogate testing unilaterally

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There was disappointment about a letter published in the Lancet to which all the Scottish Directors were signatories on the subject of anti-HBc and ALT Screening of all donations and that unilateral action had been taken.

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Dr McIntyre expressed concern that the SNBTS might seek to introduce NANBH surrogate testing without specific funding and agreement from the SHHD.

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The Lancet published a letter in response from Dr Contreras and Dr Barbara, arguing that "Transfusion services must not bow to irrational pressure for measures whose efficacy is unproven".

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Professor Barbara accepted, when he gave evidence, that it was a premise of his and Professor Contreras's argument that NANBH infections were occasional and that they had the feeling that non-A, non-B was not as severe as hepatitis B. He further described his view of the value of surrogate testing being based on the limited number of post-transfusion hepatitis reports from clinicians.

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A memo from Dr J M Forrester to Dr McIntyre in relation to the Scottish Component of Research into Non-A, Non-B Hepatitis and Blood Transfusion Services outlined that there was a suggestion that the Scottish component of the study was being abandoned. It also referenced Dr Brian McClelland's view that "we had better simply institute screening".

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Minutes of Scottish National Blood Transfusion Service Directors' meeting suggested that previous minutes were incorrect and that the Edinburgh Transfusion Centre would participate in the multi-centre study for surrogate testing for NANB hepatitis.

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In a letter to Professor Cash, Dr McIntyre stated that SNBTS wished to proceed with the research project into surrogate testing for NANB Hepatitis..

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Dr Brian McClelland submitted an application to Biomedical Research Committee relating to the study on NANBH infection in blood donors and the possibility of surrogate testing

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Dr Brian McClelland and Dr John Gillon applied to the Biomedical Research Committee of the SHHD's CSO for funding to enable the RTCs to participate in the multi-centre study on NANBH surrogate testing.

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The CSO's Biomedical Research Committee rejected the SNBTS NANBH screening research proposal on scientific grounds. Dr Forrester suggested deferring the decision being announced until the CSO had coordinated its actions with the DHSS, and envisaged that the DHSS might wish to take over the research proposal by adding a fourth English centre to the study.

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D Macniven commented that decision on whether or not to put resources into NANB testing should be properly informed by research. He suggested that "the worst of all possible worlds is that research cannot get off the ground and that they would be subjected to irresistible pressure to spend the money in any case, for the sake of improving the safety of blood and blood products.

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SSHD informed DHSS that the Biomedical Research Committee had decided not to support the ALT and anti-HBc screening of blood donation multi-centre study and the applicants were not allowed to resubmit.

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A paper titled 'Post-Transfusion Non-A, Non-B Hepatitis: Significance of Raised ALT and Anti-HBc in Blood Donors' concluded that, at the time, a surrogate screening programme was not justified but further studies were required.

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An article titled 'Incidence and Significance of Hepatitis B Core Antibody in a Health Blood Donor Population' was published. It was concluded that although surrogate testing introduction may eventually be unavoidable, only a controlled prospective study would provide the necessary information to determine the significance of donor anti-HBc levels in relation to PTH, especially NANB, in the United Kingdom.

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At a SNBTS Director's Co-ordinating Group meeting it was agreed that the financial year 1988/89 should be spent in experimentation and evaluation of high ALT levels but that positive donors should not be deferred.

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At a SBTS Directors' meeting it was agreed not to introduce Non-A Non-B Hepatitis surrogate screening in Scotland until it had become UK policy.

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