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St Thomas' Hospital's annual return for 1978 shows recorded that over a million units of commercial Factor 8 were used that year.

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Professor Edward Tuddenham was co-director of the Royal Free Hospital.

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Royal Free Hospital began to use commercial concentrate.

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Royal Free's annual return recorded that Haemophilia A patients were treated primarily with cryoprecipitate, followed by commercial concentrates, then NHS Factor 8.

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Royal Free's annual return shows 2,102,310 units of cryoprecipitate, 601,681 units of commercial concentrates and 510,200 units of NHS Factor 8.

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Dr Katharine Dormandy wrote to Dr Richard Lane, describing the Royal Free's treatment policy "to use NHS-concentrate for patients on home treatment and for those who are allergic to cryoprecipitate."

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Dr Katharine Dormandy initiated home treatment with cryoprecipitate at the Royal Free.

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Drs Kernoff and Tuddenham became co-directors of the Royal Free and moved patients from cryoprecipitate to concentrate.

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Royal Free began to measure the ratio of T4 and T8 cells in patients with haemophilia.

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The policy of deferring the elective surgery commenced, as recalled by Professor Christine Lee.

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Dr Dormandy pioneered home therapy with cryoprecipitate, as recalled by Professor Christine Lee.

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Royal Free had a policy of keeping patients on the same batch until it ran out, as recalled by Professor Christine Lee.

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Professor Lee, expressed the firm view that the Royal Free's haemophilia centre directors could not be criticised for the complete change from cryoprecipitate to concentrate, also citing the convenience and the efficiency as reasons for change.

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Royal Free used, for the first time, more units of commercial concentrates than cryoprecipitate over the course of 1978.

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The volume of commercial concentrates used at the Royal Free in 1979 was double that of NHS Factor 8 and cryoprecipitate.

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At the meeting, Dr Kernoff stated Royal Free aimed to switch home treatment patients from cryoprecipitate to concentrate with currently (September 1978) still half of the home treatment patients still using cryoprecipitate which was deemed unacceptable.

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At the meeting, Dr Rankin commented their allocation had been reduced from 100 to 65 bottles of factor VIII due to shortage. This forced his reference centre to begin transferring patients to other Centres at a much younger age. Only half of their patients on home therapy could be treated with concentrate.

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Dr Kernoff suggested that cryoprecipitate, although relatively cheap to produce, had serious clinical disadvantages and that the shortfall in NHS concentrates had to be met by buying commercial concentrate.

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In his letter to Dr Colvin, Dr Kernoff described NANBH as a serious disease with long-term consequences.

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In his letter to Mr Jones, Dr Kernoff referred to the Royal Free policy to attempt to maintain individual patients on particular brands to minimise the risk of hepatitis.

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