THE principal biochemist at Pelican House said yesterday she only became aware patient X had jaundice/hepatitis in 1994 through the investigation into the Blood Transfusion Services Board by the Expert Group.
Ms Cecily Cunningham, who was responsible for the manufacture of anti D at Pelican House while it was being made there, told the tribunal of inquiry she did recall reports from the Rotunda Hospital in July 1977 about three women patients there who had received anti D and developed hepatitis like symptoms.
She had heard about rumours from the late Mr Sean Hanratty, a senior technician at the BTSB, at a scientific meeting. She was asked by the then chief medical consultant at the BTSB, Dr Jack O'Riordan, to contact a former colleague at the Rotunda, Mrs Gwen O'Connor, to check out what was going on.
Mrs O'Connor related how the three women had anti-D from the same batch, 238, which contained plasma from patient X as well as nine other donors. On July 25th, 1977, it was decided not to use patient X's plasma any more in the manufacture of anti D.
Questioned by counsel she said she believed the decision was made by Dr Terry Walsh, then a senior member of the medical staff at the BTSB.
She did not regard it as serious at the time. The women affected had come from the same area of Dublin. She "had not really made the connection" between the anti D batch and their symptoms. She had no recollection of any doctors discussing batch 238 with her. It was "generally known" that patient X's plasma was used in the batch. It had been discussed "in general terms " at a scientific meeting though "it may have been in talks outside the meeting".
She said it may have been discussed by herself and Dr Walsh, that there may have been a connection made to November 1976, when it was noted that patient X had reacted during a plasma exchange. She did not know whether there had been any reaction among the other nine donors.
She could not explain how the decision was arrived at to stop using patient X's plasma.
"But hadn't you written in your own handwriting `batch 238 implicated'?" asked Mr James Nugent SC, counsel for the tribunal. She felt "implicated" was an unfortunate word. Dr Walsh had told her not to use any more of patient X's plasma in July as a precaution, while things were under investigation".
"As a precaution against what?" asked Mr Nugent. "They were doing an investigation."
"As a precaution against what?"
"Pending the results of an investigation."
"As a precaution against what?"
"I may be using the wrong word `precaution' wrongly," said Ms Cunningham. "I was told not to use it pending investigation."
"And what might have happened (if it was used) during the investigation?" - "Because of the connection (with 1976) it might be transfused."
"So the precaution was because it might infect others." - "The connection had not been made. It was prudent not to use it."
"Why prudent'?" - "In case of the connection."
"What would have happened, if there was a connection, to people who used the product?" - "Well, it didn't come to that."
"Mrs Cunningham, why are you prevaricating?" - "If the product was used and a connection made, more patients could be infected."
"So the precaution was to avoid infection?" - "If there was an infection."
"So the precaution was to avoid infection?" - "Well, yes."
Existing batches of anti D containing plasma from patient X continued to be distributed. She did not think this strange, considering patient X's remaining plasma was being suspended from use pending investigation. It remained the view within the BTSB that the Rotunda cases were the result of environmental hepatitis.
She believed, however, that possibly too much emphasis may have been placed (at the BTSB) on a sentence in a letter from Dr Dane of the Middlesex Hospital on September 2nd, 1977.
He was reporting his findings on a test he had conducted on a sample of patient X's plasma, and said there were "no virus B antigen particles" and that he had frozen specimens for further research "if and when any test is developed which is likely to solve the mystery". She thought Dr Dane's use of the word "mystery" at the time was "a fanciful notion of his own". "No hold" was placed on the anti D already manufactured from patient X's plasma. It continued to be used.
