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A reduction in the purchase of commercial concentrate in 1983 was due to an increase in supply of NHS material demonstrating Dr Colvin's intent to minimise risk where and when it was sensible to do so.

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In reference to the risks of AIDS in haemophilia services, possible complications in treatment were described as "Plasma product-transmitted disease, particularly hepatitis and (possibly) the acquired immune deficiency syndrome (AIDS)"

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Dr Colvin wrote that they knew little about AIDS at this time. The health service should not "spurn" commercial concentrate as they must stay aware of the risks associated with NHS material.

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It was stated that "until a positive test for AIDS and/or a vaccine is developed it should be policy to avoid use of blood products except for essential treatments and to use cryoprecipitate or plasma instead of FVIII Concentrate whenever possible."

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Dr Colvin reported that, at London Hospital Haemophilia Centre, there were 41 patients infected with HIV, of whom 31 had severe Haemophilia A, 9 had moderate/mild Haemophilia A and 1 had Haemophilia B. He recalled three children who were infected with HIV from their treatment and one partner of a patient who was infected.

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Whilst the volume of NHS concentrate used at the Leeds Haemophilia Centre increased in 1983, a very substantial amount of commercial concentrate continued to be used.

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1,497,585 units of NHS Factor 8 and 1,715,894 units of commercial concentrates were used at the Leeds Haemophilia Centre.

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Small amounts of cryoprecipitate were used with NHS concentrate and commercial concentrates were used in substantial amounts at the Leeds Haemophilia Centre.

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At a Mersey RTC meeting, there was no discussion at all about the issue of AIDS.

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In Liverpool, the use of NHS concentrate increased in 1983.

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In Liverpool, the use of NHS concentrate increased in 1984.

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Dr McVerry indicated that he had no awareness of AIDS until the September 1982 UKHCDO meeting. Up to mid 1984, there was no proven association with blood products, although he said it was reasonably clear there was a real risk at the end of 1983 or beginning of 1984.

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Dr McVerry could not recall giving cryoprecipitate to a patient in Liverpool.

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Dr McVerry stated he "was encouraged to switch to commercial F8 for two reasons". Availability and reliability of supply, and the general policy to keep an individual patient on one specific product to reduce prevalence of factor antibodies arising

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The purchase of commercial Factor 8 concentrates was undertaken via the Royal Liverpool Hospital, in part because the district health authority was able to get a better price per unit by buying in bulk, and supplied by the Royal Liverpool's haemophilia ward to Alder Hey.

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Professor Hay stated that "all patients were treated with whichever material was available. No cohorts were treated with any specific product". He stated insufficient use of cryoprecipitate was used.

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When Professor Hay arrived in Liverpool he found records to be poor and uninformative and was unable to obtain the results of the tests that had been carried out. He was told by patients that they were informed of HIV positive results by letter.

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Other documentation arising in the context of litigation suggests that "no specific priority was given to mild haemophiliacs for treatment with NHS product at the time."

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Information from legal claims relating to other children treated at Alder Hey reveal the appropriate approach to treatment.

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A child with severe haemophilia was regularly treated at Alder Hey with concentrate, "at least some of it commercial after mid-1983."

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