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The Sheffield Centre treated its patients with a mix of NHS concentrates and commercial.

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There was a greater use of NHS concentrates than commercial, although a substantial amount of the latter (and a small amount of cryoprecipitate) was still used.

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Sheffield Centre switched to heat treated product occurred at the end of May 1984 along with three other centres.

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The vast majority of treatment was with commercial concentrates, with very little NHS concentrate used. This was likely to have reflected the use of heat-treated concentrates.

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An article was published in the Lancet regarding two patients treated with Armour heat-treated who developed NANB Hepatitis and a third treated with BPL's small pool heat-treated product..

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Dr Mitchell recollected that there was no patient at Leicester with mild or moderate Haemophilia A or Haemophilia B, or with von Willebrand disorder who tested positive.

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Dr Mitchell's policy in relation to adults with severe Haemophilia A was to adhere to one batch of one concentrate as much as possible. It took a year or so to implement this approach.

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When Dr Mitchell arrived at the Sheffield Centre, the majority of patients on home treatment were receiving commercial concentrate and he did not have the ability to switch them all over to NHS concentrates given the amount received.

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Whilst there were insufficient supplies so commercial concentrates were used. Dr Mitchell would have used more NHS product if it had been available.

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The approach at the Sheffield Centre for adults with severe Haemophilia A, was to treat them with NHS concentrates as much as possible.

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Local meetings with the Inquiry team

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Dr Mitchell did not experience difficulties with obtaining sufficient quantities of cryoprecipitate or with adverse reactions to cryoprecipitate.

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Dr Mitchell acknowledged that reactions could occur but did he not recall it being a major problem.

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Children with severe haemophilia, were to be treated with cryoprecipitate by the Sheffield Centre until they went onto home treatment.

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Dr Mitchell used DDAVP and tranexamic acid wherever possible for mild and moderate haemophilia and for von Willebrand disorder. This was largely successfully, although it was not always adequate for moderate patients.

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Dr Mitchell believed there to be a connection between the use of multi-donor factor concentrates and the development of liver disease.

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Dr Mitchell understood from the 1978 Sheffield study in some patients liver disease was significant and progressive. He decided to restrict the use of large donor pool concentrates whenever possible in order to liver disease.

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Dr Mitchell argued "recurrent treatment with blood products is hazardous... The best approach seems to us to be a treatment policy" designed to reduce all the risks associated with blood products and is tailored to the needs of individual patients.

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Haemophilia B was referred to "Christmas disease" after the name of the first patient whose condition was examined in detail.

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Prior to 1952 patients were categorised under a generic diagnosis of haemophilia, but by 1952 Haemophilia B could be identified separately from Haemophilia A.

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