### Description

The Pictorial (Picturial) Blood Loss Assessment Chart (PBAC) is an attempt to get a semiquantitative measure of menstrual blood loss that is simple and inexpensive to perform. The score is proportional, but not necessarily equivalent to, the blood volume in mL (Higham et al, 1990). It can be used to monitor a patient over time, together with the patient's hemoglobin.

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%.