A helpful reminder of the potential risk of blood products

Analysis : The way the issue has been handled is a tribute to the efficient working of the National Haemophilia Council, writes…

Analysis: The way the issue has been handled is a tribute to the efficient working of the National Haemophilia Council, writes Dr Muiris Houston, Medical Correspondent.

Yesterday's announcement of a possible risk of variant CJD from plasma products used in the treatment of haemophilia is primarily a UK problem. It is almost certainly not going to result in any person with haemophilia in the Republic developing vCJD.

Nevertheless, the joint action by authorities both here and in Britain is a reminder of the potential risk of blood products as a treatment as well as the continuing uncertainty surrounding the incidence of vCJD.

There have been 147 cases of vCJD in the UK. Most are linked to the consumption of BSE-infected beef, although in two cases a link to whole-blood transfusion has been established. In the Republic just one person is known to have had the disease; she was a long-time UK resident.

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The specific concerns highlighted yesterday relate to the finding that nine people with vCJD donated plasma in the UK; their donations were subsequently pooled to make up Factor VIII and Factor IX concentrate, used by people with haemophilia to halt potentially damaging bleeding brought on by the disease. It is estimated that some thousands of patients with haemophilia in the UK received plasma from people now known to have vCJD.

None of these batches has ever been imported or used in the Republic. Therefore the only individuals who may be at risk are those who lived in the UK between 1980 and 2001. And while the British authorities have still to fully analyse the names and full address histories of all those who received the suspect plasma product, experts here estimate that, at worst, there could be 30 out of 750 Irish people with haemophilia who may have been exposed in the UK.

And even if one or two were exposed, it must be emphasised that there is no evidence that plasma products have ever carried vCJD. This is because they undergo a number of processes, including fractionation and dilution, which make it almost certain that the prion agent known to cause vCJD cannot be transmitted.

If you were exposed to the suspect product while residing in the UK, what are the implications? From a public health perspective you will be asked not to donate blood or other organs. The main practical issue is that, when you undergo certain types of specialised surgery ( involving the brain, the eye and lymph tissue), the instruments used to operate on you must be immediately destroyed.

While the issue may appear to involve almost negligible additional risk to patients, the way it has been handled is a tribute to the efficient working of the National Haemophilia Council. Set up following the Lindsay tribunal of inquiry, the council includes representatives from the National Centre for Hereditary Coagulation Disorders at St James's Hospital, the Irish Haemophilia Society and the Department of Health.

The way this latest concern has been approached is a model for professional-patient co-operation. It is a sure sign that the paternalism formerly used by doctors in such situations is a thing of the past.