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Dr Peter Jones wrote that "Cryoprecipitate is now the method of choice in treating bleeding episodes in patients with haemophilia, but, when not available, adequate therapy with fresh frozen plasma is possible and can be made relatively safe."

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Dr Jones wrote that "Thirty years ago most haemophiliacs died of exsanguination in childhood. Today they can expect to live a normal life-span."

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Dr Jones attributed the fact that people with haemophilia were expected to live a normal life-span to the identification of Factor 8, the organisation of the blood transfusion services post war - and to cryoprecipitate.

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Commercial concentrate was to be used in the management of severe bleeds, not as first choice, but as second best to cryoprecipitate. Dr Jones stated: "When insufficient cryoprecipitate is available."

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By 1977 Dr Jones remained of the view that cryoprecipitate had made a significant difference to the advantage of patients - talking of both cryoprecipitate and freeze-dried concentrates in the same breath as having made a difference, but then pointing out that Factor 8 concentrate was not without its problems, principal among which was that it was a significant cause of hepatitis.

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In her expert witness report regarding the HIV litigation, Dr Mayne described the advantages of cryoprecipitate, amongst which were "efficacy, low donor exposure, simplicity of manufacture" set against some disadvantages; its discovery "transformed Haemophilia treatment".

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Even by 1990, after concentrates had become very widely used, Dr Mayne summarised her opinion as being "the selection of mode of treatment depends upon the category or type of patient concerned. In respect that cryoprecipitate and Factor VIII concentrates are both efficacious treatments, preference of the one over the other depends on the age, the severity of the haemophilia and whether the patient is on a self-treatment programme, or requires major or minor surgery."

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In a profile of haemophilia management in Northern Ireland, Dr Mayne described how "In 1967 a milestone occurred; a revolutionary concentrate was produced called 'cryoprecipitate'."

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Although the 1970s saw a gradual shift from the use of cryoprecipitate, largely in hospitals, by 1975 around 50% of haemophilia centres were using cryoprecipitate for some part of their home therapy programmes.

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The UK Haemophilia Centre Directors Home Therapy Working Party had access to figures showing an increased use for that year of cryoprecipitate in home therapy.

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A paper by Dr Biggs published in the British Journal of Haematology in 1974 showed that the mean pool size in 1971 for Factor 8 was 192 donations.

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The paper by Dr Biggs had first been presented in draft to the Expert Group on the Treatment of Haemophilia on 20 March 1973, so by 1974, even more than in 1973, it may not have represented up-to-the-minute views in the light of greater experience with factor concentrates.

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An article by Dr Rizza and Dr Spooner reported that during 1976-80 the average ages of the patients with haemophilia who died were 46.7 years in the haemophilia A group and 48.3 years in the haemophilia B group. Comparable figures for 1969-74 were 42.3 years and 33.6 years, respectively.

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As late as January 1980 at a meeting of haemophilia reference centre directors the matter of "cryoprecipitate versus factor VIII concentrates for home therapy had been discussed at considerable length and the Reference Centre Directors had agreed that factor VIII concentrates were preferred for home therapy."

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The availability of plastics in the 1950s enabled the collection of large volumes (gallons) of porcine and bovine blood from slaughter houses. These were transported to the laboratory in Oxford where plasma was separated, fractionated into components and freeze dried. In 1954, these products were available for clinical use.

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Russell's viper venom (Stypven), at a dilution of one in a million, was used in the 1930s as topical treatment for acute bleeds. It was of limited use as it could not be used systemically (into a vein) because it was toxic.

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Cryoprecipitate remained in constant use for treating von Willebrand disorder.

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A common side effect of treatment for haemophilia A was the development of Factor 8 inhibitors. People with haemophilia B and type 3 von Willebrand disorder could also develop inhibitors, though less frequently.

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From around 1968, Factor 8 concentrate was produced under the aegis of the Lister Institute at Elstree and Oxford and by the Blood Products Unit in Edinburgh (renamed the Protein Fractionation Centre in 1970).

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In his written evidence, Dr Winter identified a number of disadvantages to cryoprecipitate: including that it was less effective clinically than concentrate, it was laborious to reconstitute, it had to be stored in deep freeze and was therefore not suitable for home treatment; and it caused side effects.

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