British doctors were urged to avoid giving children concentrates

Doctors treating haemophilia in Britain were strongly recommended to use cryoprecipitate rather than concentrates on children for safety reasons throughout the AIDS crisis, the former head of treatment in the north of England said yesterday.

Dr Peter Jones, retired director of the Newcastle Haemophilia Centre, said there was a policy from the 1970s to use cryo preferentially as it was sourced from a smaller pool of donations and considered safer.

Adherence to this policy at Newcastle, he said, contributed to a situation whereby no child aged six or under was infected with HIV. This contrasts with the situation in the Republic where four children, including one aged two and another aged three, were infected with HIV through commercial concentrates.

In previous testimony, Prof Ian Temperley, the former director of the National Haemophilia Treatment Centre, said he believed advice on the matter, on which he said he depended, only emerged from UK haemophilia treatment directors in around 1983. He further suggested the advice was not followed by UK treaters, noting it "didn't seem to carry much weight".

Dr Jones said, however, that a "strong recommendation" to treat children with cryo existed in the UK for a number of years before 1985. At his hospital a policy of treating children aged under six with cryo emerged in the 1970s following outbreaks of hepatitis B linked to commercial concentrates. This policy continued until 1985 when products which had been heat-treated were introduced.

He conceded, however, the policy was not absolute. There might be clinical reasons to depart from it, such as in the case of major trauma or surgery.

He further noted that children aged six or over were switched onto concentrates under a home-treatment programme throughout the period in question. This practice continued even after 1983 when there were heightened fears about AIDS.

A similar policy of treating mild haemophiliacs with cryo or DDAVP, a synthetic drug, instead of concentrates also existed at Newcastle. As a result, there were no cases of HIV in mild haemophiliacs at the regional centre, in contrast to the Republic which had a similar population of haemophiliacs.

All 76 haemophiliacs infected at the north of England centre were severe haemophilia A patients.

Dr Jones said the haemophilia population in Newcastle had an input "at every stage" in the choice of products. He would have discussed, on an individual patient basis, the merits of locally made versus commercial concentrates. Regular efforts were made to furnish haemophiliacs with "everything that we knew" about AIDS.

He said testing of patients for HIV began in December 1984, and all were informed of their results by May 1985. Asked how he succeeded in doing this in six months, he said the issue was simply made "the priority".