DR David Dane, of the Middlesex Hospital in London, was mystified. "I can't explain it at all. I do not know what was going on in their minds to make them do this."
Dr Dane, a consultant virologist, was speaking to the hepatitis C tribunal yesterday about a decision at Pelican House in 1977. It had continued to issue anti-D made from patient X's plasma, which had been tested by Dr Dane at the Blood Transfusion Service Board's request (BTSB).
He did not think "it was any secret the donor (patient X) had jaundice". The specimens were "obviously jaundiced" with "a greenish tinge".
On September 2nd, 1977, he had written to the then chief medical consultant at the BTSB, Dr Jack O'Riordan, informing him that patient X's specimens had tested negative for hepatitis B. He was retaining samples for further tests which might "solve the mystery".
He agreed with Mr James Nugent SC, for the tribunal, that he did not regard that letter "as a certificate of any kind". Mr Nugent informed the tribunal that Dr Dane had "upbraided" him for describing the letter as "a limited certificate" during earlier evidence.
Nor could he (Dr Dane) understand why Ms Cecily Cunningham, principal biochemist at the BTSB, should have taken exception to his use of the word "mystery" in that letter. "I do not think there was anything sinister about the use of the word. Dr O'Riordan may have used it to me".
He agreed there was a belief then that viruses were not transmitted through immunoglobulin anti-D. This was based more on observation than science. He added that "whatever the belief was", it was not the practice to use plasma from a patient with jaundice.
At the Middlesex Hospital, they "would normally discard everything six months back at least" where there were suspicions of a product. Everything would be put on hold immediately. "I think they (BTSB) did so and then released it later."
Questioned as to whether it was safe to continue to use anti-D where, as in the patient X instance, it had been cleared of hepatitis B alone, he replied: "No, certainly not. It ought to be withdrawn immediately the association was made."
He continued: "Personally, if two cases (of hepatitis-like symptoms associated with anti-D) occurred, it would have been enough to put everything n hold and begin an immediate investigation."
The seven such cases notified to the BTSB between August and December 1977 would have been "more than enough" to put a hold on everything. "The first three specimens were enough." he said.
After the fourth case, from another hospital, it could not be argued that the Rotunda (where the first three cases originated) was doing anything wrong. By then it ought to have been clear "it must be the anti-D".
Dr Dane told Mr Paul Gallagher SC, for the BTSB, he had never heard of a plasma exchange patient being used as source for the manufacture of anti-D before patient X. He would have thought "it was asking for trouble"
Mr Gallagher put it to him that a World Health Organisation (WHO) report in 1978 had suggested the suitability of such a source for anti-D plasma.
Dr Dane believed that had the 1977 Dublin cases been reported, that WHO article would not have been written.
He told Mr David McParland, counsel for the McCole family and Positive Action, he considered it "extraordinary" that patient X was used as a source for plasma as she had received multiple transfusions. This meant the risk of her having infective hepatitis increased "a hundredfold".
