Among patients with hemophilia, musculoskeletal outcomes are increasingly being determined by ultrasound, though clearer guidelines are needed, according to research published in Research and Practice in Thrombosis and Haemostasis.

Despite improvements in treatment over the past several decades, patients with hemophilia frequently suffer from recurrent hemarthrosis and hemophilic arthropathy. While new treatments help to reduce bleeding events, long-term joint issues are common, and outcomes relating to joints are needed for this patient population.

Previous research suggests that musculoskeletal ultrasound may help in the evaluation of bleeding episodes. Over the past 20 years, several scoring systems for musculoskeletal ultrasound have been proposed, though none has been adopted universally in different health care systems.

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For this paper, researchers aimed to define how musculoskeletal ultrasound is used among patients with hemophilia, and to establish consensus around the use of this method. The researchers conducted a global survey and a 2 day consensus meeting to evaluate usage patterns across health care settings.

Overall, of 313 health care centers to which the survey was sent, 76 (24.3%) responded. Among these, 55% used full diagnostic ultrasound routinely and 52% used any type of point-of-care musculoskeletal ultrasound routinely. The majority of respondents (76% of those who used full diagnostic and 90% who used point-of-care musculoskeletal ultrasound), furthermore, agreed with the proffered definitions for both methodologies. The authors outlined deviations from the proposed definitions in the published paper.

Several recommendations followed from the 2 day consensus meeting, including that clear definitions of examination types should be established, and further that a standardized scoring system for ultrasound use should be developed and implemented.

The authors enumerated the other expert recommendations, including:

  • A basic understanding of ultrasound needs to be attained to increase user confidence.
  • A tiered ultrasound scoring/measurement system that builds in complexity but allows for comparison across tiers should be adopted.
  • Future endeavors should include standardization of ultrasound acquisition protocols for detection of [musculoskeletal] disease in the joints of persons with hemophilia, with a focus on the index joints (ankles, knees, and elbows).

Other recommendations, specifically for clinical and technical workshops around ultrasound use in hemophilia, were published in the paper.

Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Bakeer N, Dover S, Babyn P, et al. Musculoskeletal ultrasound in hemophilia: results and recommendations from a global survey and consensus meeting. Res Pract Thromb Haemost. 2021;5(5):e12531. doi:10.1002/rth2.12531