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A study conducted at Oxford shows 7 out of 16 Haemophilia B patients on regular treatment with Factor 9 concentrate who were tested for their liver function had a persistently abnormal Aspartate Aminotransferase ("AST") level.

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Batch history for BPL Factor IX concentrates indicates that Factor IX pool sizes were larger than those used to manufacture Factor VIII.

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Dr Maycock explained that Factor IX pools were sometimes created from 2 or 3 subpools increasing the pool size.

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Dr Rainsford thought it was worth continuing to transfuse high potency factor IX because of its effectiveness and because no cases of hepatitis encountered were close to moderately severe.

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Dr Bidwell wrote to Dr Maycock to ask if the Factor IX pool sizes could be increased to the maximum capacity of the freeze drier (360 bottles).

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Dr Maycock replied to Dr Bidwell to state there is no objection to the final pool being increased to 500 litres. It was to be prepared from 2 or 3 subpools each of which would pass safety tests, including RIA test for HBsAg.

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Dr Allen wrote to Dr Maycock highlighting that Cutter's product Konyne had an extraordinarily high rate of icteric hepatitis developing from it. This ranged between 50 and 90 percent. Half of these cases proved fatal and Cutter's source of blood was 100 percent from Skid-Row derelicts.

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Dr Aronson, in a paper on Factor IX concentrates, referenced the high number of cases reported of icteric hepatitis in Factor IX concentrates. A survey of sera from haemophilia B patients revealed that the overwhelming majority of patients treated with Factor IX concentrates had markers indicating prior infection with HBV.

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Dr Craske reported that most reference centres now used commercial heat-treated Factor IX. Dr Mortimer suggested Directors be recommended to only use heat-treated products now due to increased availability.

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Spreadsheet shows annual consumption of Commercial Factor Concentrates mainly for Oxford but also includes data from across the country for individual years (ranging from 1976 to 1983). It reveals that untreated Factor IX continued to be used after 1985 despite it being readily available from the same year.

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BPL were cautious to release the heated Factor IX product due to potential risk of thromboembolic sequelae being activated. This was allayed following studies in November 1984 which explains the delay in its clinical trials occurring in July 1985 and eventual widespread distribution to October 1985.

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Dr Snape's understanding was that during the first nine months of 1985 most treatment centres continued to use the BPL unheated product, although heat-treated commercial Factor 9 products were available.

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Dr Smith described how Factor IX concentrate was thought to carry the risk of venous thrombosis at the site of infusion (possibly fatal) when administered at a high dosage. Similarly, reports of thrombosis occurred at higher frequency in the early 1980s supposedly due to activated Factor IX. Clinicians had to choose between unheated Factor IX and run the risk of transmitting NANBH or AIDS, or buying heated Factor IX concentrate where it wasn't tested for thrombogenicity.

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Results released for total number of HIV positive 'people with blood disorder' (PwBD) resident domestically and abroad between 1979 and 2000.

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941 people with severe haemophilia A were infected with HIV as opposed to only 18 with severe haemophilia B between 1979 and 2000.

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Professor J Garrott Allen compared donor blood from Skid-Row to volunteer donated blood. This showed that Skid Row blood was ten times more likely to lead to cases of icteric hepatitis.

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A study titled Haemophilia Associated AIDS in the United States 1981 to September 1987 noted that one purification process for factor XI included the use of ethanol, a substance found to be an effective inactivator of HIV. Researchers demonstrated a 10-fold decrease in HIV infectivity in plasma following exposure to 20 percent ethanol in a common manufacturing process.

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Study on clinical factors associated with progression to AIDS in an Italian Cohort of HIV-Positive haemophiliacs showed factor IX recipients were found to develop full-blown AIDS significantly earlier than factor VIII recipients.

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An estimate by the UK Haemophilia Doctors' Organisation suggested that around 360 children with bleeding disorders were infected with HIV as children in the UK.

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Haemophilia care in Liverpool had traditionally been divided between Alder Hey Children's Hospital and the Royal Liverpool Hospital, the patients graduating from one to the other in their mid teens.

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