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In Dr Rosemary Bigg's book "The Treatment of Haemophilia A and B and von Willebrand's Disease", she cited Roderick Murray's 1955 work, which identified that even an exceptionally small amount of blood containing a virus could be infective.

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A study carried out by Gocke said that, in total, 74% of the recipients of blood con_taining the Australia antigen exhibited either hepatitis or an immune response.

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At a meeting of blood transfusion officers they discussed the proposal that the pool size used at the Cambridge drying plant for plasma should be reduced to a size of no more than 10 donors.

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The British Medical Journal article had a footnote which said that "We understand that only small pools are now used by the Ministry of Health for the preparation of blood products."

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In a letter to a Dr Lehane, Dr Maycock stated that all large pool plasma should be replaced with small pool plasma and that the large pool plasma could be diverted to Liverpool so that the small pools could be examined for infectivity.

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A study of British Army records concluded that plasma was more icterogenic than whole blood and one reason for this was likely because one bottle of plasma came from a pool to which many donors contributed.

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In a letter to Dr Maycock, Dr Drummond stated that he did not think it was justifiable to continue to issue large pool plasma which had a 10% incidence of homologous serum jaundice as opposed to 1% for small pools, and that were a case of this to go to court it would not be justifiable since it was practicable to make small pools.

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A study by Biggs in the British Journal of Haematology described the process of preparing Factor 9 concentrate using 45-50 litres of plasma.

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Pools used to prepare antihemophilic factor were 14-22 litres in size. This amounted to the use of pools made from a maximum of 90-110 donations. There was said to be no "contra-indications to the prolonged or repeated use of the product."

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Dr Peter Wolf commented "The risk of contamination of blood with the virus of infective hepatitis limits a single fractionation batch to a donor pool of 50" but "Human A.H.F. concentrate, produced in this way at multiple centres throughout the country, could provide sufficient to treat all the known classical haemophiliacs in Great Britain."

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Dr Maycock and Leon Vallet proposed to "retain the present pool size (30L) because of the risk of transmitting serum hepatitis."

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A working party on human antihaemophilic globulin decided "it was considered inadvisable, when planning increased production, to increase the plasma pool volume much above this size (30-40 litres in volume), unless further observations indicated that the risk was smaller than the present series of cases suggested."

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Dr Maycock wrote that in the UK antihaemophilic globulin ("AHG") was made from donor pools of 60-100 donors, and described a "paucity of reports of hepatitis" associated with this.

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Dr Jean Grant recorded that "It has been found that a minute fraction of a millilitre of virus-laden blood was enough to cause hepatitis and it was for this reason that the production of large-pool plasma, made from the contributions of more than 300 donors, was abandoned in favour of limited pools derived from not more than ten donors."

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Dr Robert Cumming and colleagues commented "Because of the risk of transmitting serum hepatitis, small-pool operation is preferable, in preparing antihaemophilic fractions."

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Dr Rosemary Biggs wrote to the MRC in advance, to say that she "also thought that we should probably consider the question of serum hepatitis and, in view of the American activities, whether or not it would be reasonable to increase the pool size for fractionation."

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Due to the pressure for an increase in the pool sizes used to make AHF, there was a meeting of a working party on the use of the cryoprecipitate method.

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Dr Cumming explained that "after consultation with clinicians using this material, it was decided that Edinburgh should use a pool of 8 litres. The clinical opinion in Edinburgh was that a pool of this size was sensible for general use but that larger pools could be used for major surgery where large quantities were required for one patient."

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Factor 8 and Factor 9 were made at the Plasma Fractionation Laboratory in Oxford. The number of donations in the mean pool size for Factor 8 in 1969 was 160 donations; in 1970 it was 192 and the same in 1971. In terms of Factor 9, larger pools were used: in 1969, 439 donations were the average, in 1970 it was 384, and in 1971, 300.

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Dr Biggs stated "The use of freeze dried concentrate (in comparison to cryoprecipitate) did not cause a dangerous increase in episodes of jaundice".

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