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Dr Mitchell did not experience difficulties with obtaining sufficient quantities of cryoprecipitate or with adverse reactions to cryoprecipitate.

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Dr Mitchell acknowledged that reactions could occur but did he not recall it being a major problem.

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Children with severe haemophilia, were to be treated with cryoprecipitate by the Sheffield Centre until they went onto home treatment.

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Dr Mitchell used DDAVP and tranexamic acid wherever possible for mild and moderate haemophilia and for von Willebrand disorder. This was largely successfully, although it was not always adequate for moderate patients.

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Dr Mitchell believed there to be a connection between the use of multi-donor factor concentrates and the development of liver disease.

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Dr Mitchell understood from the 1978 Sheffield study in some patients liver disease was significant and progressive. He decided to restrict the use of large donor pool concentrates whenever possible in order to liver disease.

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Dr Preston confirmed his views to the Inquiry that "The Department of Health should have responded by pushing for ways to inactivate the virus in the blood, or given patients the choice of an alternative."

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A survey between Sheffield and the Royal Free showed that approximately one third of the patients studied had the appearance of chronic active (aggressive) hepatitis.

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Dr Preston's policy was to treat people with mild haemophilia with DDAVP as soon as it became available.

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Dr Preston stated in his evidence to the Inquiry that whilst the hepatitis risk from commercial products was substantially greater than from NHS products, "there were insufficient NHS products for the treatment of Royal Hallamshire Hospital patients".

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Dr Preston confirmed that part of his approach to patients was to "keep individual patients on the same concentrate, and the same 'batch' for as long as possible to minimise exposure to different blood donations"

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Dr Preston does not recall telling patients that the treatment they were receiving might expose them to the risk of chronic liver disease.

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Dr preston's view was that the amount of Factor 8 (and Factor 9) given to patients was very much less than the majority of other reference centres.

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Dr Preston's approach to purchasing a number of different commercial concentrates was "not putting all the eggs in one basket in case something happened with the supply chain..." and "keep individual patients on the same concentrate, and the same 'batch' for as long as possible to minimise exposure to different blood donations."

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It was the view of the reference centre directors at the special meeting on 13 May 1983 that cryoprecipitate was not particularly easy to use as there was no guarantee of the amount of Factor 8 in each bag, and it was not a particularly useful therapeutic option for major surgery or major bleeds.

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Dr Saad Al-Ismail told the Inquiry that "maybe in retrospect it was probably a misplaced trust in the medicine licensing agency in the UK, in that we never used a product which is not licensed. We never used a product which has not proved to be efficacious."

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Dr Saad Al-Ismail told the Inquiry that prior to the establishment of the Swansea Haemophilia Centre medical records "would have been in the general records [and] would not be in the haematology department".

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Dr Saad Al-Ismail who worked with Professor Bloom in Swansea recalled Professor Bloom stating that NANBH was probably not going to be an issue for the vast majority of patients.

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Dr Saad Al-Ismail was one of many clinicians that gave evidence to the inquiry who argued that patients were informed of the risks of hepatitis.

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Professor Charles Hay in evidence acknowledged that there was little prophylaxis during the 1980s and referenced the Prophylaxis and the Home Therapy Working Parties' audit of their roll out of home therapy which showed that it was slower than he had realised.

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