Peter Bernard Allan Kernoff
Authors: Christine Lee, Clifford Welch, Hannah Kernoff
Journal: BMJ (2006)

​PeterPeter Kernoff published the first description of the bleeding disorder variant von Willebrand's disease. This groundbreaking work, which appeared in 1974 when Peter was based at the Oxford Haemophilia centre, became a citation classic and helped to set in motion many studies elucidating structural, functional, and immunological relationships between factor VIII and von Willebrand factor, and the role of the latter in haemostatic/thrombotic mechanisms.




Figure 1




Inhibitory antibodies to factor VIII remain the biggest challenge for haemophilia treatment. It was as early as 1984, when Peter Kernoff was consultant haematologist at the Royal Free Hospital in London, that he was the lead investigator in a clinical trial using pig factor VIII to treat those patients with these antibodies. Until recently this strategy was the mainstay of treatment and there is no doubt that it saved many lives.

In 1978 he established a bank of stored serum samples from patients, taken at each clinic visit when they were treated with clotting factor concentrate. These samples enabled an enormous amount of epidemiological work to be published on the emerging transfusion transmitted infections of hepatitis and HIV. They helped to establish that unheated concentrates caused non-A, non-B hepatitis (now known as HCV) in 100% of recipients; they provided early information about the prognosis of HIV infection, and Peter played a key role in helping to establish the Royal Free as a centre for HIV treatment.

HIV was a major challenge for all involved in haemophilia—particularly in the early 1980s when so little was known. Peter Kernoff played a major part in the deliberations of the UK Haemophilia Directors Organisation (UKHCDO) as its vice chairman—not an easy task, but his judgments were based on a long experience of haemophilia and a sound scientific approach. It was therefore rewarding that he treated the first European patient in the first trials of recombinant factor VIII at the Royal Free Hospital in 1988.

Peter also used his clinical experience of treating patients with factor XI—a rare, inherited bleeding disorder that mainly affects Ashkenazi Jewish people, many of whom live in north London and attend the Royal Free Hospital—to further the understanding of this disorder with studies on genetics, its clinical manifestations, and treatment with the first factor XI concentrate.

Peter Bernard Allan Kernoff was born in Bushey, Hertfordshire, in 1944, the son of a consultant physician. He was educated at the City of London School and studied medicine at the London Hospital Medical College, qualifying in 1967. He did house jobs in Barnet before joining the Oxford Haemophilia Centre, where he spent his formative professional years.

After completing research on inhibitory antibodies to factor VIII, the clotting factor deficient in people with haemophilia, and working in New York at the Columbia Presbyterian Medical Center, as assistant professor of medicine, he was appointed consultant haematologist and the first director of the Katharine Dormandy Haemophilia Centre and Haemostasis Unit at London's Royal Free Hospital in 1978.

In 1980 he computerised patient records using a purpose built computer and the services of a dedicated computer programmer. The data provided by this system have underpinned all clinical and much research work at the centre—one of the largest in Europe—until the present time.

In 1988 Peter Kernoff initiated and led the development of UK NEQAS (the National External Quality Assessment Scheme) for blood coagulation, in which participation by hospital laboratories is a requirement for clinical pathology accreditation and laboratory practice, to include a comprehensive range of laboratory tests for haemostasis. This took NEQAS from its early beginnings limited to quality assessment of INR (international normalised ratio) testing to the much broader scheme that we now have.

Peter was a Department of Health appointed member of the Central Blood Laboratories Authority, secretary to the World Federation of Haemophilia, and vice chairman of the UK Haemophilia Directors Organisation. He was a physician of immense clinical skill and his opinion was widely sought. Many remember him for his career advice and support. However, following a cardiac arrest in 1991 he was tetraplegic for the last 15 years of his life and was unable to work again. He had a tracheostomy and gastrojejunostomy, as he could not swallow and suffered repeated aspiration. Despite his profound physical disability and the virtual loss of his speech, which he recovered to an extent during the first year after his cardiac arrest but lost again because of the effects of jaw fractures, he developed his own unique and powerful system of communication. He was nursed at home from 1993 onwards, and, despite his fragile condition, spent only few and brief periods in hospital.

He leaves a wife, Hannah, also a consultant haematologist.

Peter Bernard Allan Kernoff, consultant haematologist and first director of the Katharine Dormandy Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, London, 1978-91 (b Bushey, Hertfordshire, 1944; q the London Hospital Medical College 1967; MD, FRCP, FRCPath), died from bronchopneumonia on 27 February 2006.