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The NANBH risks associated with Factor 8 concentrates were the subject of discussion at the Haemophilia Working Party's meeting.

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At the meeting of the Haemophilia Working Party, it was agreed that all registered haemophiliacs on regular treatment should be fully screened for hepatitis at their regular three-month visits to the major haemophilia centres.

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Dr Kernoff stated 25% of all Factor VIII used was in the form of cryoprecipitate which was unsatisfactory at the Royal Free Hospital.

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A clinical study done by Dr Dormandy with the US counterparts demonstrated that haemophiliacs treated exclusively with the new concentrates suffered raised transaminases more commonly than UK patients who were treated with cryoprecipitate.

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In his oral evidence, Professor Howard Thomas agreed that he had given the Glasgow Symposium the message that there would be problems in the future with hepatitis, fibrosis and cirrhosis.

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Dr Kernoff agreed with Dr Dormany that factor concentrates exposed recipients to a greater risk of infection because of the large sizes of the pools from which they were made.

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Dr Craske published an article titled 'An outbreak of hepatitis associated with intravenous injection of Factor VIII concentrate' in The Lancet

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Dr Biggs served as director of the Oxford Reference Centre until 1977 when she was succeeded by Dr Rizza.

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Dr Biggs served as director until 1977 when she was succeeded by Dr Rizza.

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Due to the co-location and cooperation of the PFL and Oxford Haemophilia Centre, it made the switch from cryoprecipitate to factor concentrates relatively early.

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Between 1969 to 1974, cryoprecipitate use at the Oxford Haemophilia Centre dropped from 21.99% to 3.86% of total Factor 8 material used, while the use of NHS concentrate rose from 45.93% to 60.89% of the total.

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By 1975 there was only about 25% of Haemophilia A patients using home therapy.

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In 1977, Dr Bidwell said Factor 9 requirements had increased substantially. It did not allow for prophylactic treatment except for occasional short periods. But prophylaxis for severely affected patients was allowed where no substantial increase in usage occurred.

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By 1976, 42.6% of the material used at Oxford Haemophilia Centre was NHS Factor 8 concentrate, just 1.54% was cryoprecipitate, and the rest was commercial concentrate (Hyland & Immuno).

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Following an increase in plasma supplied, nearly double, the Oxford Centre was able to transfer several patients from commercial to NHS concentrate.

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The Oxford Haemophilia Centre used Profilate and Koate. Dr Rizza described them all as equally effective clinically and they usually use Hemofil.

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NHS Factor 8 was always in very short supply and reserved as far as possible for young children and adolescents. Dr Rizza wrote that most severely affected patients had changed from NHS to commercial factor VIII, especially those who use larger amounts of factor VIII.

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A report produced by Dr Rizza held demonstrated how the view of the impact of hepatitis on haemophiliacs changed from the early to late 1970s and how by the late 1970s there were a significant number of people who had significant number with abnormal liver histology consistent with chronic liver disease.

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A study by J Spero reported persistent abnormalities in liver-function for haemophiliac patients. A significant number demonstrated results of anti-HBc (56 of 65, or 86 percent). Many showed signs of chronic liver disease.

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Dr Mayne cited a paper by J Spero that structural abnormalities of the liver were described in patients. The paper discusses a study on haemophiliacs deficient in factor VIII or IX where significant numbers showed signs of chronic liver disease.

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