The Netherlands' blood transfusion service took steps to limit the use of imported blood products from as early as late 1982, the Lindsay tribunal heard yesterday.
Prof Willem van Aken, former medical director of the Blood Transfusion Service Board's (BTSB) Dutch equivalent, the CLB, said that by the end of 1982, AIDS was seen as a real threat, and it was felt it would be "absolutely utterly irresponsible" not to act.
This was despite the fact, he said, that there was much disagreement at the time about the nature of the disease and as to whether it was blood-borne.
He said that from November 1982 the CLB organised a series of meetings with representatives of the Dutch haemophilia society, physicians and the government. In January 1983 it published guidelines for doctors, recommending cryoprecipitate in preference to inter mediate-purity concentrates, which in turn were recommended ahead of imported concentrates.
Consequently, said Prof van Aken, the CLB's supply of commercial concentrates - which, have been linked, internationally, with most HIV infections - halved from 6-7 million units to 3.5 million units.
This contrasts with the BTSB which, in addition to not consulting haemophiliacs about treatment options, increased its supply of commercial concentrates to hospitals from 2.4 million units in 1982 to three million in 1984.
Prof van Aken said the CLB felt it had a duty to warn the haemophilia community of the dangers arising from the use of concentrates. They were seen as carrying a higher risk as they were sourced from large pools of donations in contrast to cryo, which was usually sourced from just four donors.
On various occasions, he said, the CLB made efforts to tell patients what it knew about AIDS. There was no question of playing down the risks, he said.
In late 1982, he said, the CLB conducted clinical trials on patients to try to establish which products were safest regarding HIV infection. The results, which became available in April 1983, suggested commercial concentrates carried the highest risk.
Prof van Aken said the data were sent to the head of public health services in the Netherlands, who recommended to the government that commercial concentrates be banned. The recommendation was not accepted, however, due to the lobbying of haemophiliacs who were concerned their quality of life might suffer.
From a haemophilia population in the Netherlands of about 1,100, an estimated 170 were infected with HIV, half through imported concentrates and the other half through locally made products, said Prof van Aken. This translates as an infection rate of about 15 per cent, half the Irish infection rate of 105 HIV cases from an estimated 350 haemophiliacs, the vast majority of infections occurring through commercial concentrates.
