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The Haemophilia Centre Handbook recorded that "All Haemophilia Centres now teach most of their severely affected patient to treat themselves at home

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The role of the designated reference centres in England and Wales was coordinating the functioning of the haemophilia service. Many centres in England and Wales were relatively small and look to larger reference centres for guidance and advice

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The topic of home treatment policy was discussed at this haemophilia centre directors meeting. Dr Antony Brittan's film on home treatment was shown and formed the basis for the discussion. Dr Matthews outlined the policy at Oxford was using freeze dried concentrate and Dr Dormandy that the Royal Free Hospital was using cryoprecipitate

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Dr Biggs after sending around a protocol for a clinical trial to confirm whether it was better for patients to have prophylactic or on demand treatment concluded that a trial would be difficult to organise but was needed, and that perhaps the only place where it could be done would be at Lord Mayor Treloar College.

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At a Haemophilia Directors' meeting many of the haemophilia centre directors were pushing to obtain permission to purchase the good commercial blood products manufactured overseas

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At a meeting of Haemophilia Centre directors Dr Maycock "said that although the screening of donors...would reduce the number of infected batches, all infected batches would not be excluded since the tests would not pick up all levels of Hepatitis B virus and some Hepatitis was caused by viruses not detected by the test".

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At a meeting of Haemophilia Centre directors it was recorded "that a study home therapy in patients with haemophilia was being organised at St Thomas' and the Oxford Centre . Also discussed at this meeting was hepatitis, liver function tests and pool sizes.

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At the 8th meeting of the UK Haemophilia Centre directors it was recorded that during 1976 that 729 patients had been on home treatment.

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In a paper by Peter Jones titled "Home Treatment Working Party" 87 haemophilia B patients were recorded as being on home therapy and 65 haemophilia A patients were recorded as receiving prophylaxis in 1978 which was about double the amount of those in 1977.

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In a paper titled "Jaundice and factor VIII antibodies in treated patients with haemophilia and Christmas disease" a suggestion was made that "Perhaps now that the virus associated Australian antigen can be studied a method will be found to remove that antigen from concentrated materials". The paper's authors concluded that "We feel that the increased risk of clinical illness is not so great a to overbalance the advantages of the use of concentrates".

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Dr Craske and others published a journal article in The Lancet about an outbreak of Hepatitis A and B in patients with haemophilia in Bournemouth who had been given commercial factor 8 concentrate. He suggested that "commercial factor VIII concentrates should be reserved for the treatment of life-threatening bleeds in all haemophiliacs and for covering major operations".

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Dr Craske gave a talk entitled Virus hepatitis complicating replacement therapy at the Symposium on Haemophilia.

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At a Haemophilia Reference Centre Directors meeting, Professor Edward Blackburn observed that "It seems that the Radio and Television authorities have the right to edit and comment on their presentations as they think fit."

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Dr Craske produced a report of the Haemophilia Directors Hepatitis Working Party, which presented evidence of specific protection conferred by a previous batch of Hemofil against contracting Non-A Non-B Hepatitis.

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In a Haemophilia Centre Directors' Hepatitis Working Party report, Dr Craske concluded that "there remains much work to be done to devise methods to prevent the threat of chronic liver disease clouding the undoubted benefits that large pool concentrates have brought."

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In a Haemophilia Centre Directors' Hepatitis Working Party meeting, Dr Kirk described the results of the prospective survey on hepatitis carried out at Edinburgh and Alton, which show a higher proportion of patients treated with freeze dried products who had consistently abnormal liver enzyme tests, compared with the boys treated with cryoprecipitate.

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In a Haemophilia Centre Directors' Hepatitis Working Party meeting, it was agreed that the NHS Factor 8 associated hepatitis study should start on 1 June 1978.

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Haemophilia centre directors agreed in principle that it was a good idea for patients to be kept on one type (or preferably one batch) of concentrate for long periods.

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Dr Craske requested haemophilia centre directors send in details of cases of chronic hepatitis on a new form which the Haemophilia Centre Directors' Working Party would draw up and distribute to centres.

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The reason for the DHSS' suggestion that patients be kept on one type or one batch of concentrate was to simplify analysis and presentation of results, increase the chances of identifying icterogenic material and permit the withdrawal of icterogenic bottles.

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