Doctors treating haemophiliacs in the UK faced a dilemma in the early 1980s over which blood product to use, a British blood specialist has told the Lindsay tribunal.
Dr Brian Colvin, haematology director at the Royal London Hospital, said there was a great deal of uncertainty about whether to use domestically produced blood products or commercial ones imported from the US.
He said he preferred to use blood products from the National Health Service (NHS). These products had not been heat-treated to kill viruses, but the donor pool would only have had a small amount of HIV-infected blood, since the UK in the early 1980s had a low incidence of the virus.
Blood products from the US, on the other hand, had been heat-treated, but this process may not have fully inactivated the HIV present, as there would have been a high incidence of the virus in the US donor pool.
He told the tribunal that using imported products brought the risk of infecting previously uninfected patients, but this was preferable to not treating them at all.
Supplies of NHS blood products, the tribunal heard, constantly ran short, and so haemophiliac treaters had been forced to use imported commercial products.
Dr Colvin said he had to use a mixture of domestic and imported blood products. In haemophilia centres across the UK, he said, the proportion of NHS to imported products used would have varied significantly.
The NHS did not produce heat-treated factor 8 blood product until May 1985, and factor 9 until October 1985.
He also told the tribunal earlier yesterday of his shock at hearing about the potential danger of using a blood product from Armour Pharmaceuticals.
This company provided blood products to the State and the UK, including heat-treated Factorate which infected a haemophiliac with HIV at St James's Hospital, Dublin, in February 1986.
Dr Colvin said he first heard about what he called "a possible difficulty" with the product at a World Haemophilia Federation conference in Milan in 1986.
He immediately phoned his hospital in London, telling his colleagues to "get rid of any Armour products in the hospital". Before this incident, he said, he had no detailed knowledge of the product "good, bad or indifferent".
Dr Colvin told the tribunal earlier yesterday he was not entirely pleased with how he treated some haemophiliac patients in the early 1980s.
He said there were advantages and disadvantages to his practice of treating haemophiliac children with cryoprecipitate, rather than a blood concentrate.
He said he used cryoprecipitate as a protection against patients contracting hepatitis C.
Dr Colvin said he used cryoprecipitate because he believed hepatitis C might have been a problem, although at that time it was not a major concern.
However, he said: "The caution I displayed may have had bad consequences". One disadvantage of his treatment was that some children may have had a greater chance of developing joint disease.
He told the tribunal he was very conservative in the way he practised medicine, and cryoprecipitate was generally available and more cost-effective.
He said there was often a lack of scientific and medical evidence available with which to make a decision. In those cases, doctors must often have had to rely on their feelings.