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Professor Ludlam described in his oral evidence how in many cases children with Haemophilia A would begin with cryoprecipitate before moving to home treatment.

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Professor Ludlam described how batch dedication was introduced towards the end of 1984 and it unclear why this was not produced earlier.

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Professor Ludlam, under counsels questions, amended his earlier submission that in the late 1980s, NANB Hepatitis was believed to be a mild non-progressive condition following the first liver biopsy undertaken in 1985. He corrected this view to say that he was aware of the liver biopsy undertaken in Sheffield in 1978, and thus there was a likelihood of prior knowledge of the condition of NANB Hepatitis earlier than the late 1980s.

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Professor Ludlam stated that during the 1980s that there was a wide view at the time regarding the seriousness of NANB Hepatitis. The lack of evidence about its progressiveness that resulted in the belief that it's possible it might not be progressive however it became clear that there was a wide range of ways in which it rates at which it did progress between different people.

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Dr Saad Al-Ismail who worked with Professor Bloom in Swansea recalled Professor Bloom stating that NANBH was probably not going to be an issue for the vast majority of patients.

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Dr Saad Al-Ismail was one of many clinicians that gave evidence to the inquiry who argued that patients were informed of the risks of hepatitis.

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Inquiry updates timetable and opens registration for September hearings

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Professor Bloom held that during the 1970s that although most patients were infected with NANB Hepatitis, patients did not suffer from clinical liver disease.

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Professor Bloom held that during the 1980s most haemophilia specialists recognised the risk of hepatitis in haemophiliacs after treatment with concentrates, however the general belief was that bleeding was still the primary cause of death amongst patients.

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Professor Bloom stated that by 1 January 1985, all Haemophilia Centres should have received the AIDS advisory document.

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The AIDS Advisory document recorded that heat-treated commercial factor products were available. On the subject, Professor Bloom stated that during the early 1980s, several observers noted that there appeared to be a reduced risk of HIV infection and/or immunological abnormalities in patients with haemophilia B compared to those with haemophilia A.

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Following the fifth meeting by the AIDS Group, on 17 June 1985, more centres had transitioned to using commercial heat-treated Factor 9.

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Professor Bloom held, that around 1983-1984, that it was not necessary to inform patients or the parents of patients of the risks of AIDS.

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Professor Bloom held that he existence of the viruses causing serum hepatitis was well known to doctors caring for haemophiliacs during the 1960's, 1970's and later.

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The reference centre at the Manchester Royal Infirmary was part of a regional haemophilia service in North West England, which included Manchester Children's Hospital and the Lancaster Haemophilia Centre.

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Most patients being treated for haemophilia who were treated at the Manchester Royal Infirmary would have been informed that there was a high likelihood of them having AIDS. They were informed either by letter or through routine appointments.

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One of the aims of the appointment of Dr Wensley was to create a better understanding with the RTC and "a greater availability of cryoprecipitate and better treatment for all
haemophiliacs."

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Manchester Royal Infirmary's role was described in an article: "today with modern methods of treatment and patient assessment.. haemophiliacs are able to lead a near-normal, albeit hazardous, life. Their great salvation comes in small plastic bags containing as the cryoprecipitate."

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Dr Delamore preferred to administer cryoprecipitate but observed that if freeze-dried concentrate could be altered to be dissolved more easily and in smaller volume, "we would probably choose that preparation in preference to cryoprecipitate."

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The annual return for 1976 showed substantial use of cryoprecipitate, NHS concentrate and Kryobulin, with some use of Hemofil. Both FEIBA and porcine Factor 8 were also used in Manchester Haemophilia Centre.

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