Measures:
(1) tampons
(2) towels
(3) clots or flooding
Procedure: The woman keeps track of the number of each blood measure together with a degree estimate during the time bleeding occurs. This is recorded on a chart with pictures of each measure (hence the "picturial") and a grid for recording the number for each day.
|
Measure
|
Finding
|
Factor
|
|
tampons
|
slightly soiled
|
1
|
|
|
moderately soiled
|
5
|
|
|
heavily soiled
|
10
|
|
towel
|
slightly soiled
|
1
|
|
|
moderately soiled
|
5
|
|
|
heavily soiled
|
20
|
|
clots
|
small
|
1
|
|
|
large
|
5
|
Clots and flooding may be measured by comparing the size to standard coinage or by actually measuring the material.
points for total blood loss =
= SUM((factor for each item) * (number of each item))
Interpretation:
• minimal score: 0 (amenorrhea)
• maximal score: > 600
• The cutoff for menorrhagia is variable. Higham et al used a score >= 100 as "positive" for menorrhagia. Janssen et al used >= 185 as the cutoff.
Performance:
• The items can absorb different amounts of blood and yet look visually similar.
• Reid et al found the PBAC score to poorly correlate with menstrual blood loss. Their series included a woman with a blood loss of only 28 mL yet who had a score of 228 (this might be the exception and probably reflects significant recording error).
• Higham et al found a score >= 100 had a sensitivity and specificity of > 80%.
• Janssen et al found a score >= 185 had a positive predictive value of 86% and negative predictive value of 85%. The predictive value of a woman's complaint of heavy bleeding was only 56%, while the presence of a hemoglobin < 12 g/dL was 74%.
