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The Queen Elizabeth Hospital return for 1983 showed some treatment with cryoprecipitate in hospital but predominantly treatment with NHS concentrate and Factorate in both hospital and home settings.

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The return for 1984 showed for the Queen Elizabeth Hospital that there was predominantly treatment with NHS concentrate and Factorate in both hospital and home settings.

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It was noted at Working Party meeting on the Treatment of Haemophiliacs that there was a shortfall of 3.5 million units of Factor 8 which it was agreed should be made up by commercial Factor 8.

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Professor Franklin wrote to Dr Lane registering his concern about the shortfall, which meant that the Centre might have to treat patients with commercial product who had never been exposed to it in the past.

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The West Midlands Working Party held an extraordinary meeting to discuss the implications of the use of Factor 8 concentrates in light of the death of two people with haemophilia from AIDS and a treatment policy was agreed

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Professor Bloom told the audience at a Haemophilia Society meeting that one of his patients "may have a mild form" of the syndrome.

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Professor Lee confirmed that no changes were made in the Royal Free's treatment policies until heat-treated products became available at the end of 1984

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NETR Haemophilia Working Party agreed to use heat-treated material whenever possible and to treat all new patients and those with mild haemophilia with heat-treated NHS concentrate or small pool Factor 8 concentrate if treatment with cryoprecipitate or DDAVP was not possible.

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The Royal Free's annual return for 1983 showed that commercial concentrates remained the principal treatment for Haemophilia A.

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The Royal Free's annual return for 1984 showed that commercial concentrates remained the principal treatment for Haemophilia A, although the volume of NHS concentrates increased.

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Dr Kernoff wrote to patients explaining that it would not be possible to change everybody to heat-treated products immediately. The overall objective of the Royal Free's policy was said to be to give the safest possible treatment to an individual.

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In a letter to John Watt, it was stated that Dr Ludlam planned to start an active home therapy programme for some of his haemophilic patients.

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In his witness statement, Professor Ludlam accepted that cryoprecipitate had transformed the treatment of patients with Haemophilia A and allowed most bleeds in non-inhibitor patients to be treated effectively.

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Donor blood plasma was redirected from cryoprecipitate production to concentrate manufacture.

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Professor Ludlam did not proactively raise the question of AIDS risks with patients.

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Dr Boulton wrote to Professor Ludlam, warning that the South East Scotland Blood Transfusion Centre was at the limits of production of concentrates for home therapy and indicated that Professor Ludlam may consider the necessity for buying some commercial product. Dr Boulton also encouraged Professor Ludlam to maximise use of the cryoprecipitate programme.

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At the meeting with Dr Boulton, Dr Ludlam agreed to make additional efforts to keep within the monthly allocation of concentrate from PFC, while Dr Boulton reiterated his warning that there would be need to buy more commercial Factor VIII.

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Similar concerns regarding use of Factor VIII concentrates and purchase of commercial products were raised at the meeting of the Lothian Health Board Area Executive Group.

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Dr Boulton continued to express concerns that Dr Ludlam's home therapy programme was using a large proportion of the allocation from PFC and that he may need to buy commercial Factor VIII if the usage pattern continued.

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Dr Boulton stated that Dr Ludlam was beginning to use less PFC material in favour of cryoprecipitate and that this was an encouraging trend. Edinburgh also sourced Factor VIII from Inverness and Glasgow.

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