A threefold increase in the incidence of hepatitis B among haemophiliacs in the early 1980s should have made it crystal clear to the Blood Transfusion Service Board that imported blood products posed risks to haemophiliacs, counsel for the Irish Haemophilia Society claimed at the tribunal yesterday.
Opening a new document on the incidence of hepatitis B in Ireland, Mr John Trainor SC said it showed that prior to 1980, when nearly all blood products for haemophiliacs were sourced from Irish blood, there were few cases of hepatitis B among haemophiliacs.
However, in 1983/84 there was a threefold increase and the introduction of imported factor concentrates was believed to be responsible.
Counsel put it to Mr John Keating, a laboratory technician with the BTSB at the time, where he was responsible for testing blood donations for hepatitis B, that he would have been aware of this increase as his help had been acknowledged in compiling the figures. Mr Keating said he must have been.
Mr Trainor explained that no specific test was available at the time for HIV and in an attempt to guard against its transmission other tests called surrogate tests were used.
Hepatitis B was found to be prevalent in the same populations that were at high risk of developing AIDS, such as drug addicts, and as a result was used in some countries as a marker for, or surrogate test for, HIV. Mr Keating said he didn't believe he was aware of that.
Counsel put it to Mr Keating that if hepatitis B was getting through to the haemophilia population, any other disease for which it was a marker, such as HIV, was also likely to be getting through and the BTSB would have been aware of this.
Mr Keating said that assumption could not be drawn based on available knowledge at the time.
Mr Trainor asked if there was any discussion within the board about whether or not it ought to stop distributing imported clotting agents, given that they were transmitting infection. Mr Keating said he did not recall. He was not consulted on which products would be stocked or selected for use.
Counsel asked if the desirability of doing surrogate testing, which might reduce the transmission of HIV in the early years, was considered at Pelican House. The witness said he had no recollection of this being discussed.
"Did anybody mention that surrogate testing should be looked into?" Mr Trainor asked.
"Not that I recall," Mr Keating replied. He said he remembered surrogate tests for non-A, non-B hepatitis (later known as hepatitis C) but not surrogate tests for HIV.
The BTSB began testing blood donations for HIV in October 1985 and the timeliness of this action will be examined in the third phase of the tribunal.
It also emerged yesterday that marker tests for hepatitis C were in place in Austria and Germany since 1968 but were not recommended to the board of the BTSB until 1986. The test did not receive ministerial approval. A test for hepatitis C was finally introduced by the board in 1991.