Point of care ultrasound in haemophilia: Building a strong foundation for clinical implementation

.Haemophilia A and B are X-linked recessive diseases that result in a deficiency in coagulation factor VIII and IX respectively. These low levels of factor cause a decrease in thrombin formation, which in turn promotes haemorrhage into articular joints.1 The resultant blood products stimulate chondrocyte apoptosis, synovitis and subchondral bone changes, leading to arthropathy.2 Even a single episode of haemarthrosis can potentially increase the risk of poor long-term joint outcomes.3, 4 Accurate diagnosis and timely therapy of joint haemorrhage are then critical to patient care. Investigators utilize physical assessment for diagnosis; however, recent studies have shown that the physical exam alone lacks accuracy in determining the extent of haemarthrosis and its resolution.3, 5, 6 As a result, patients/providers may prematurely lower their factor treatment doses and return to normal physical activity, which may lead to re-bleeding. Several imaging modalities are used in the diagnosis of haemarthrosis. Ultrasound (US), when compared to magnetic resonance imaging (MRI) and computed tomography (CT), is quick, non-ionizing, inexpensive and accurate in diagnosing soft tissue abnormalities in patients with haemophilia.3, 7 Point-of-care-ultrasound (POC-US) has recently gained recognition in its use as an adjunct tool in the haemophilia setting.6, 8 However, the user dependency of POC-US necessitates that users be properly trained and competent in the technology to avoid misuse and misdiagnosis. Guidelines and recommendations should be established to facilitate appropriate training, use, and implementation of POC-US as a diagnostic tool in haemophilia.