In 1974 he became a Consultant in Haematology at the Royal Infirmary, Sheffield and at the Royal Hallamshire Hospital and achieved Professor in Haematology in 1986. He has advised the World Health Organisation (WHO) on haemophilia and the Department of Health on hepatitis C and haemophilia. Professor Preston previously gave evidence at the Lindsay Tribunal in Dublin in 2000. He was a member of the UK Haemophilia Reference Directors Working Party on Chronic Liver Disease in Haemophilia.
Professor Preston explained how he had total control over which products the Sheffield Haemophilia Centre used during the 1970s -1980s. He explained that they prepared the Cryoprecipitate themselves at Sheffield and concentrates were sourced from commercial companies. Jenni Richards QC referenced Annual Returns from that period which showed the treatments in use consisted of Cryoprecipitate, NHS Factor VIII, Armour Factor VIII, Hemofil and Kryobulin. Both commercial and NHS products were used. Factor VIII was used for the treatment of Christmas disease and Hemofil, Armour Factor VIII and Kryobulin were used for home treatment. Porcine Factor VIII was used for treating patients with inhibitors and DDAVP was used for mild/moderate haemophilia, but if this did not work, then they were also treated with Factor VIII concentrate as were patients with von Willebrands Disease. The use of Cryoprecipitate was gradually reduced in favour of factor concentrates. Professor Preston said he had preferred to treat patients with NHS Factor VIII because he considered it was safer. He said the pool sizes were smaller than the ones for commercial products and the blood donors were volunteers, however there was an insufficient supply of this treatment.
Professor Preston stated that the risks of blood and blood products were well-known for a long time and that, in his opinion, not a great deal of thought had been given to the risks of infection. He went on to explain that at that time, haematologists were uninformed of chronic liver disease and had not had any specific training in this field.
Professor Preston explained how in the 1970s, screening tests on patients had revealed abnormal liver function. Consequently, biopsies were carried out on patients and revealed signs of cirrhosis, chronic persistent hepatitis (non-progressive), and aggressive hepatitis, which was serious and progressive. All patients had been symptom free on biopsy. Professor Preston considered the liver disease was caused by the use of factor concentrates. He stated that in each case, the biopsy procedure was explained to the patient and the patient’s consent obtained. When he was asked if biopsies were carried out for treatment or research purposes, Professor Preston answered that they were carried out for diagnosis and not just for research.
Professor Preston was questioned on the Minutes of the 8th meeting of the Hepatitis Working Party in December 1980 wherein the results of a study into chronic liver disease carried out by the Sheffield Haemophilia Centre and the Royal Free Hospital were discussed. 40 patients were biopsied, a third of patients had chronic hepatitis, two thirds had persistent hepatitis, three had cirrhosis and one oesophageal varices.
Professor Preston was asked about the report of Dr. Mannucci which had been raised in the Lindsay Tribunal. Professor Preston pointed out that Dr. Mannucci’s patients were much younger and therefore the infection progressed slower in those infected in childhood, as opposed to his patients, who were adults, and had a heavier viral load after receiving concentrate after concentrate, equivalent to millions of blood transfusions. Multiple genotypes were found to be in haemophiliac patients.
Professor Preston was asked about his knowledge of HIV and AIDS and whether he had informed his patients. He was unclear of when he first learned about the risk of AIDS from blood/blood products but did recall that all of his patients had been tested for HIV. He remembered that patients and their families were invited to a meeting where they were informed about the risks. Professor Preston said he ensured test results were given to his patients at ‘special’ private appointments. He stated that he recalled the anxiety in haemophiliac patients in 1983 about HIV/AIDS, but said they considered there was insufficient evidence at that time to warrant restriction of treatments. He recalled discussion about this with other Haemophilia Centre Directors.
Professor Preston recalled trialling heat-treated products at the Sheffield Haemophilia Centre. Patients consented to stored samples of sera being tested. Partners and family members had also been tested. Stored samples had also been used for the testing of hepatitis C. Professor Preston explained that these tests were carried out without patients’ consent.
Ms Richards questioned Professor Preston about the Revlon Pharmaceutical Company and referenced letters concerning the payment of funds from this company to the Sheffield Haemophilia Centre. Professor Preston explained that funds were received from this company and it had been used for research purposes. He was also questioned about the ‘Haemostasis Club’ and explained these were occasional meetings held for Haematologists from local departments close to Sheffield.
Professor Preston was asked about the development of Parvovirus. He said that in haemophiliacs this was a serious infection and that it had been important to distinguish this infection from NANB.
Sir Brian Langstaff thanked Professor Preston for his attendance and good humour when giving his evidence.