Safe clotting agent for haemophiliacs was available in 1980s, says Italian blood expert

Cryoprecipitate, the safest clotting agent available to Irish doctors treating haemophilia in the 1980s, was suitable even for major surgery and in severe cases of bleeding, a European blood expert told the Lindsay tribunal yesterday.

Prof Pier Mannucci, a Milan-based haematologist, said cryoprecipitate was "always adequate" for acute bleeding, unless the treatment continued for 20 days or more.

The inquiry heard that Irish doctors were advised to use cryo in the treatment of mild and previously unexposed haemophiliacs, as well as for children.

In certain instances, commercial concentrates, which had been linked to HIV transmission, had been given to patients instead.

Mr Nicholas Butler, counsel for three Irish doctors, Prof Ian Temperley, Dr Helena Daly and Dr Fred Jackson, asked whether there were instances where cryo was inadequate for the treatment of mild haemophiliacs.

Prof Mannucci replied the only situation he could envisage where it would not be adequate would be lengthy surgery in which the patient was at risk of "circulatory overload" due to receiving large volumes of the product. However, he said, in his experience, this happened "very, very rarely".

He had carried out major surgery since the 1960s using only cryo for cover, he said.

The tribunal has heard that a mild haemophiliac, with the pseudonym Declan, was given concentrate three days after minor surgery in May 1984, infecting him with HIV. The decision was made by a junior doctor at St James's Hospital, Dublin, who has not been named.

Prof Temperley has told the tribunal he used cryo to treat children and mild haemophiliacs but "if you had somebody coming in with a major accident, or something like that, then you would naturally gravitate to concentrate".

In other evidence, Prof Mannucci said HIV was initially thought of as "an American problem" which was not of immediate relevance to European doctors. With the evidence we have now, he said, "we probably did overlook many things . . . this is a confession I am prepared to do in front of this tribunal."

However, he added, a delay in responding to the threat of AIDS was "quite universal" among doctors.

Prof Manucci said concentrates which had been heat-treated to kill HIV were introduced in Italy in 1985, prompting a withdrawal of unheated material on July 15th that year.

A circular was issued to treatment centres by the ministry for health and information was subsequently passed on to patients.

No one, however, was ordered to collect unheated material stored in people's home fridges, said Prof Mannucci. "This was not done, probably because it was very difficult." He emphasised that there was no claim of any patient developing HIV after the recall notice went out.