Point-of-care Ultrasonography Should Be Included in Hemophilia Care Strategy, Study Advises

Point-of-care ultrasonography enables improved diagnostic accuracy, and allows for more targeted treatment and better monitoring of therapy response in hemophilia patients with joint complications, a study suggests.

The study, a review of published articles, “Point-of-care Ultrasonography in Orthopedic Management of Hemophilia: Multiple Uses of an Effective Tool,” was published in the HSS Journal.

Hemarthrosis (bleeding into joints) can be common in people with hemophilia A and B; joints affected include the ankles, knees, and elbows.

Repeated joint bleeding leads to hemophilic arthropathy, or permanent joint disease, that is visible on imaging studies.

Despite the use of prophylactic (preventive) treatments that work to avoid arthropathy, a “significant percentage of patients experience inflammatory and/or degenerative  articular changes” in their joints, researchers at La Paz University Hospital in Madrid, Spain, reported, noting a need for better prevention, diagnosis, and treatment of such complications.

Magnetic resonance imaging (MRI) and ultrasonography (US), both imaging tools, are known to be safe and effective in detecting early joint damage in patients with hemophilia, before such changes are apparent in physical exams.

Ultrasonography, in particular, has been used for more than 50 years to diagnose multiple conditions and assist in the treatment of certain injuries, including musculoskeletal disorders related to hemophilia. And, the research team added, “US has shown more sensitivity than MRI for detecting the presence of hemarthrosis.”

Point-of-care US (POC-US) refers to the use of ultrasound by trained professionals to diagnose diseases wherever a patient is being treated, whether in a hospital, ambulance, or a remote village. Its use is growing in developing countries with more limited access to medical technology.

To further determine the usefulness of POC-US in people with hemophilia, researchers conducted a review of the most recent literature on this technique. They emphasized studies into POC-US use in early diagnosis of joint damage, differential diagnosis of articular pain, follow-ups of joint injury, and as a guidance tool for arthocentesis (joint aspiration) and intra-articular injection.

Their review determined that POC-US is capable of detecting joint changes in hemophilia patients, which allows for more effective management of resources, and faster and more efficient treatment.

But these benefits were dependent on operator skill, and POC-US was able to assess marrow edema, or a buildup of fluid in the bone marrow (such edemas are also called bone marrow lesions).

“Recruitment of a seasoned operator, particularly one who specializes in radiology of patients with coagulation disorders, is ideal,” the study said.

Multiple protocols have been developed over the past two decades to assist in POC-US examinations of hemophilia-caused damage, it added, but their “clinical relevance” needs further study.

Still, “POC-US should become a valuable and reliable tool in hemophilia clinical practice when nonradiologist physicians are trained in the technique,” the research team concluded, adding that this imaging tool “should be considered [part of] a strategy of comprehensive care.”