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Professor Annette Von Drygalski

MD, PharmD, RMSK

Biography

Annette von Drygalski, MD, PharmD, RMSK is a Professor of Clinical Medicine in the Division of Hematology/Oncology, and Director of the Center for Bleeding and Clotting Disorders, Department of Medicine, at the University of California, San Diego.
Dr. von Drygalski earned her medical degree from Friedrich Alexander University Erlangen/Nürnberg and Ludwig Maximilians University in Munich, Germany. She completed residency in Internal Medicine at the Medical College of Wisconsin, Milwaukee, and fellowship in Hematology and Oncology at the University of California, San Diego and The Scripps Research Institute.
Dr. von Drygalski is board certified in Hematology. She is a member of the American Society of Hematology, the World Federation of Hemophilia, the Hemostasis and Thrombosis Research Society and the Foundation for Women and Girls with Bleeding Disorders.
Dr. von Drygalski is dedicated to the care of patients with hemophilia and other bleeding disorders. In this role, Dr. von Drygalski von Drygalski has pioneered musculoskeletal ultrasound for rapid joint bleed detection and joint evaluation in hemophilia. She is certified in musculoskeletal ultrasound by the American Registry for Diagnostic Medical Sonography, and has developed the Joint Activity and Damage Exam (JADE), a validated ultrasound protocol to quantify synovial and osteochondral changes as well as inflammation in the hemophilic joint. She is also the Director of the CME-accredited course “Musculoskeletal Ultrasound in Hemophilia” at the University of California San Diego

Key Publications

  • BC Joseph, TC Whisenant, EJ Cooke, JY Zhou, N Falah, A von Drygalski. Synovial Gene Expression after Hemarthrosis Differs Between FVIII-Deficient Mice Treated with Recombinant FVIII or FVIII-Fc Fusion Protein. PLoS One. 2025 May 19;20(5):e0320322. doi: 10.1371/journal.pone.0320322. eCollection 2025.PMID: 40388523 

  • EJ Cooke*, BC Joseph*, CA Nasamran, KM Fisch and A von Drygalski. (*equal contributions). Maladaptive Lymphangiogenesis is Associated with Synovial Iron Accumulation and Delayed Clearance in FVIII-/- Mice After Induced Hemarthrosis. JTH 2023 Sep;21(9):2390-2404. doi: 0.1016/j.jtha.2023.04.022. Epub 2023 Apr 26

  • S Sedaghat, JV Luck, A von Drygalski, E Fu, J Il Park, KG Gehling, Y Ma, S Ball; EY Chang, J Du, H Jang. Hemosiderin Quantification in Hemophilic Arthropathy using Quantitative Magnetic Resonance Imaging. Sci Rep. 2025 Apr 24;15(1):14353. doi: 10.1038/s41598-025-99085-7.

  • B Lundin, N Bakeer, A Dunn, S Gibikote, S Keshava, R Ljung, O Papakonstantinou, H Pergantou, K Srike, A von Drygalski, N Zhang, P Babyn, S Dover, A Doria. International Prophylaxis Study Group (IPSG) Haemophilia Joint MRI Scale Version 2.0. Haemophilia 2024 Apr 18. doi: 10.1111/hae.15010. Online ahead of print.

  • RFW Barnes, P Aguero, C Hanacek, A Flores, B Steiner, C Bailey, DV Quon, R Kruse-Jarres, A von Drygalski. Consistency of Serial Ultrasonographic Joint Tissue Measurements by the Joint tissueActivity and Damage Exam (JADE) protocol in Relation to Hemophilic Joint Health Parameters. BMC Musculoskelet Disord. 2023 Apr 15;24(1):299. doi: 10.1186/s12891-023-06419-5.PMID: 37061676

  • N Gallastegui, BUK Steiner, P Aguero, C Bailey, R Kruse-Jarres, DV Quon, C Hanacek, LM Volland,  RFW Barnes, A von Drygalski. The Role of Point-of-Care Musculoskeletal Ultrasound for Routine Joint Evaluation and Management in the Hemophilia Clinic – A Real World Experience. BMC Musculoskelet Disord. 2022 Dec 21;23(1):1111. doi: 10.1186/s12891-022-06042-w.

  • P Aguero, RW Barnes, A Flores, A von Drygalski. Teleguidance for Patient Self-Imaging of Hemophilic Joints Using Mobile Ultrasound Devices –– a Pilot Study. J Ultrasound Med. 2022 Aug 19. doi: 10.1002/jum.16084. Online ahead of print.

  • S Gopal, Richard FWB, LM Volland, D Page, A von Drygalski. Diagnosis of Hemophilic Hemarthrosis: Development of a Patient-Derived Symptom Assessment Tool Using Musculoskeletal Ultrasound for Validation. Haemophilia 2022; doi: 10.1111/hae.14591. Online ahead of print

  • AM Shayeb, RFW Barnes, C Hanacek, P Aguero, B Steiner, C Bailey, D Quon, R Kruse-Jarres, A von Drygalski. Quantitative Measurements of Hemophilic Joint Tissues by Point-of-care Musculoskeletal Ultrasound: Associations with Clinical and Functional Joint Outcome Parameters. Haemophilia. 2021 Jun 25. doi: 10.1111/hae.14368. Epub 2021 Jun 25.
  • A von Drygalski A, G Pasta, H de la Corte-Rodriguez. Ultrasound and Patient Self-imaging in Hemophilia“ (Letter to the Editor) Haemophilia. 2020 Nov 25. doi: 10.1111/hae.14208. Online ahead of print.

  • J Zhou, J Wong, Z Berman, A Lombardi, E Chang, A von Drygalski. Bleeding with iron deposition and vascular remodeling in subchondral cysts: A newly discovered feature unique to hemophilic arthropathy

  • S Gopal, RFW Barnes, EJ Cooke, JY Zhou, I Levin, P Emery, TH. Hughes, T Manon-Jensen, MA Karsdal, A von Drygalski. Systemic Vascular Basement Membrane Markers Linked to Synovial Vascular Remodeling are Biomarkers of Hemarthrosis in Patients with Hemophilia. J Thromb Haemost. 2021 Feb 15. doi: 10.1111/jth.15268. Online ahead of print.

  • H Jang, A von Drygalski, J Wong, J Zhou, P Aguero, X Lu, X Cheng, Y Ma, E Chang, J Du. Ultrashort Echo Time Quantitative Susceptibility Mapping (UTE-QSM) for Detection of Hemosiderin Deposition in Hemophilic Arthropathy: a Feasibility Study. Magn Reson Med. 2020 Jul 14. doi: 10.1002/mrm.28388. Online ahead of print.

  • J Zhou, RFW Barnes, G Foster, A Iorio, TJ Cramer, A von Drygalski. Joint Bleeding Tendencies in Adult Patients with Hemophilia: It’s not All Pharmacokinetics. Clin Appl Thromb Hemost. 2019 Jan-Dec; 25:1076029619862052. doi: 10.1177/1076029619862052.

  • C Schroeder, RFW Barnes, L Volland, S Nguyen, A von Drygalski. Effects of therapeutic rock climbing on joint health in hemophilia patients with severe arthropathies. Haem Pract 2018; 5(1). doi:10.17225/jhp00115

  • JY Zhou, KC Rappazzo, L Volland, M Brackman, B Steiner, R Kruse-Jarres, DV Quon, C Bailey, EY Chang, A von Drygalski. Pocket handheld ultrasound for evaluation of the bleeding hemophilic joint: a novel and economic way to recognize joint effusions. Haemophilia. 2018 Mar;24(2):e77-e80. doi: 10.1111/hae.13429. Epub 2018 Feb 12.
    A von Drygalski, RE Moore, S Nguyen, LM Volland, TJ Cramer, TH Hughes, J Du, EY Chang. Advanced Hemophilic Arthropathy: Sensitivity of Soft Tissue Discrimination with Musculoskeletal Ultrasound. J Ultrasound Med. 2018 Aug;37(8):1945-1956. doi: 10.1002/jum.14541. Epub 2018 Jan 24.

  • X Lu, Y Ma, EY Chang, A Dimov, Q He, A von Drygalski, Y Wang, J  Du. Simultaneous Quantitative Susceptibility Mapping (QSM) and R2* for High Iron Concentration Quantification with Three-Dimensional Ultrashort Echo Time (UTE) – an Echo Dependence Study. Magn Reson Med. 2018 Apr;79(4):2315-2322. doi: 10.1002/mrm.27062. Epub 2018 Jan 4.

  • S Nguyen, X Lu, Y Ma, J Du, EY Chang & A von Drygalski. Musculoskeletal Ultrasound for Intra-Articular Bleed Detection: a Highly Sensitive Imaging Modality Compared to Conventional Magnetic Resonance Imaging. J Thromb Haemost. 2018 Mar;16(3):490-499. doi: 10.1111/jth.13930. Epub 2018 Jan 19.

  • A von Drygalski, KC Rappazzo, RFW Barnes, EY Chang. Knee Fat Pad Volumes in Patients with Hemophilia and their Relationship with Osteoarthritis. Arthritis. 2017;2017:1578623. doi: 0.1155/2017/1578623. Epub 2017 Dec 5.

  • A von Drygalski and E.Y.Chang. Ultrasound Imaging in Hemophilia. Leading Article. The International Monitor on Hemophilia. 2016, 24: 15-19 (not indexed in pubmed)
  • DM Ignas, AS Doria, A von Drygalski, VS Blanchette, EY Chang, S Dover, K Fischer, S Gibikote, SN Keshava, F Querol, A Abad, P Babyn. Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an International Prophylaxis Study Group global survey. Haemophilia. 2020 May 22. doi: 10.1111/hae.14006. Online ahead of print

  • E Martin, RFW Barnes, CM Moran, S Holle, TH Hughes, RE Moore, A von Drygalski. Efficacy and safety of point-of-care ultrasound-guided intra-articular corticosteroid joint injections in patients with hemophilic arthropathy. Haemophilia. 2016 Aug 3. doi: 10.1111/hae.13057. [Epub ahead of print]

  • W Kidder, EY Chang, C Moran, S Rose, and A von Drygalski.   Propagation of Hemophilic Arthropathy – the Role of Abnormal Angiogenesis and Vascular Remodeling for Recurrent Joint Bleeding. Microcirculation. 2016 Jul;23(5):373-8. doi: 10.1111/micc.12273

  • V Bhat, M Olmer, S Joshi, DL Durden, T Cramer, R Barnes, ST Ball, TH Hughes, M Silva, LV Luck, R Moore, LO Mosnier, A von Drygalski. Vascular Remodeling Underlies Re-bleeding In Hemophilic Arthropathy. Am J Hematol. 2015 Nov;90(11):1027-35. doi: 10.1002/ajh.24133. Epub 2015 Oct 8.

  • W Kidder, S Ngugen, J Larios, J Bergstrom, A Ceponis, A von Drygalski. Point-of-care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful hemophilic arthropathy. Haemophilia. 2015 Jul;21(4):530-7.

  • A Ceponis, I Wong-Sefidan, CS Glass, A von Drygalski.Rapid musculoskeletal ultrasound for painful episodes in adult hemophilia patients. Haemophilia 2013;19:790-798 [Epub 2013 May 15]

Key Institutions

  • University of California San Diego
    Hemophilia and Thrombosis Treatment Center, Department of Medicine
    USA

Current Positions/Chairs

  • Director
    Center for Bleeding and Clotting Disorders

    Professor of Clinical Medicine

    University California San Diego

Research Interests

  • Pathobiology of hemophilic joint disease, and impact of vascular remodeling on re-bleeding, perpetuated bleeding, target joint development and progression of hemophilic arthropathy

  • Utility of point-of-care musculoskeletal ultrasound for rapid bleed detection and the management of hemophilic arthropathy

  • Etiology of hypertension in hemophilia and relation to hemophilic arthropathy

  • “FVa activity augmentation” for the development of novel bypassing strategies in patients with inhibitors, bleeding with novel oral anti-coagulants and traumatic bleeding

Achievements

  • Discovery that maladaptive synovial lymphangiogesis in FVIII deficiency results in impaired iron clearance, affecting cartilage repair

  • Discovery that vascular remodeling is associated with joint bleeding, is unique to hemophilia and not present in other arthritic conditions, and probably predisposes to recurrent bleeds

  • Patient perception and physician judgement are unreliable to determine if pains are associated with bleeding in hemophilia as ascertained my objective imaging with musculoskeletal ultrasound

  • Introduction of point-of-care musculoskeletal ultrasound into hemophilia treatment centers to assist with diagnosis of pains and management of hemophilic arthropathy

  • Discovery that the prevalence of hypertension is significantly higher in patients with hemophilia compared to the general population

  • Development of superFVa, a variant of FV that is resistant against inactivation by Activated Protein C and stabilized via disulfide bonds

Publications

April 18, 2024

International Prophylaxis Study Group (IPSG) Haemophilia Joint MRI Scale Version 2.0. Letter to the Editor

Authors

Lundin B, Bakeer N, Dunn AL, Gibikote S, Keshava SN, Ljung R, Papakonstantinou O, Pergantou H, Strike K, von Drygalski A, Zhang N, Babyn P, Dover S, Doria AS

Citation

Haemophilia. 2024; 30: 862-864. DOI: 10.1111/hae.15010

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May 22, 2020

Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an international prophylaxis study group global survey

Authors

Ignas DM, Doria AS, von Drygalski A, Blanchette VS, Chang EY, Dover S, Fischer K, Gibikote S, Keshava S, Querol F, Abad A, and Babyn P on behalf of the Ultrasound Taskforce of the Imaging Expert Working Group of the International Prophylaxis Study Group (IPSG)

Citation

Haemophilia 2020: 26 (4): 685 - 693

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May 22, 2020

Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an international prophylaxis study group global survey.

Authors

Ignas DM, Doria AS, von Drygalski A, Blanchette VS, Chang EY, Dover S, Fischer K,Gibikote S, Keshava S, Querol F, Abad A, and Babyn P on behalf of the Ultrasound Taskforce of the Imaging Expert Working Group of the International Prophylaxis Study Group (IPSG)

Citation

Haemophilia. 2020 Jul;26(4):685-693. doi: 10.1111/hae.14006. Epub 2020 May 22. PMID: 32441402.

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May 10, 2018

Use of ultrasound for assessment of musculoskeletal disease in persons with hemophilia: Results of an International Prophylaxis Study Group (IPSG) survey.

Authors

Doria AS, von Drygalski A, Blanchette VS, Chang EY, Dover S, Fischer K, Sridhar G, Shyamkumar K, Querol F, Babyn P.

Citation

Haemophilia 2018; 24 (S5): 391, W- P- 085

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