The Lindsay tribunal heard for the first time yesterday that a BTSB-made clotting agent, known as cryoprecipitate, was responsible for infecting a haemophiliac with HIV.
Dr Emer Lawlor, deputy medical director of the Irish Blood Transfusion Service, as the BTSB has become, said "in all probability" the product infected a patient in Galway University Hospital, who was identified by the pseudonym Fionn, in 1985 or earlier.
Until now, the tribunal heard of haemophiliacs being infected with the AIDS virus only through imported commercial concentrates or BTSB-made factor 9.
However, Dr Lawlor said she had examined Fionn's medical records and it appeared he was treated only with cryo prior to October 1985 when he tested positive for the virus.
She said she believed this was the only case of a haemophiliac being infected with HIV through cryo in the State. It was not, however, unique in an international context, she said.
Cryo had been considered as one of the safest products to use in the mid-1980s in terms of avoiding transmission of AIDS as it was sourced from a smaller pool of donors - about five on average compared to up to 2,000 donors in the case of commercial concentrates. Doctors regarded it as more unwieldy, however, and less effective for the treatment of the bleeding into joints which afflicted haemophiliacs.
Dr Lawlor said she believed Fionn underwent a second test in November 1985 and this confirmed he was HIV-positive. But she could not be certain that the infection came to the BTSB's attention until April 1986, as it was not recorded in documentation until then. She agreed, however, that the BTSB may have known earlier.
Dr Lawlor, who was giving evidence in the context of a review of documentation, as she was not a senior employee of the board at the time, admitted that there was no evidence of any steps to follow up the case. This was despite the fact that it raised doubts over the safety of both BTSB cryo and BTSB factor 9, which was made from a blood derivative, called cryosupernatent, sourced from the same donations from which cryo was made.
Dr Lawlor said: "I don't think it was thought through at the time." She said finding the donor who was the source of contamination "would have been like looking for a needle in a hay stack".
Mr Gerry Durcan SC, for the tribunal, put it to her, however, that "the needle would have been out there" in the sense that once it was confirmed cryo was infected it raised the possibility of factor 9 being infected.
Dr Lawlor agreed with this, and said Fionn's case would have shown HIV was in the Irish donor pool. She agreed there should have been a withdrawal of all potentially-infectious products although this was not done.
Regarding Galway, she said it seemed 39 vials of an infectious batch of factor 9 - which had not been heat-treated to guard against HIV - remained at the hospital in 1986 despite a recall notice being sent out by Pelican House. She believed the product was destroyed as there was no evidence of it being used.
Fionn's last treatment before testing positive for HIV was in May 1985 when he was given cryo that was sourced from donors who gave blood in October 1984. The donor who was the source of contamination has never been identified.
Turning to Limerick Regional Hospital, where about 30 haemophiliacs were treated, Dr Lawlor said there was no evidence of it operating a recall of non-heat-treated factor 9 in 1986 either.
