{"id":412,"date":"2017-10-24T08:30:19","date_gmt":"2017-10-24T12:30:19","guid":{"rendered":"https:\/\/elearning.wfh.org\/resource\/grille-devaluation-illustree-des-pertes-sanguines\/"},"modified":"2022-09-21T15:29:50","modified_gmt":"2022-09-21T19:29:50","slug":"grille-devaluation-illustree-des-pertes-sanguines","status":"publish","type":"resource","link":"https:\/\/elearning.wfh.org\/fr\/resource\/grille-devaluation-illustree-des-pertes-sanguines\/","title":{"rendered":"Grille d\u2019\u00e9valuation illustr\u00e9e des pertes sanguines"},"content":{"rendered":"<h3>Pictorial Blood Loss Assessment Chart (PBAC)<\/h3>\n<p class=\"\"><strong>Authors\/developers<\/strong><br class=\"\" \/>Higham JM, O\u2019Brien PMS, Shaw RW<\/p>\n<p class=\"\"><a href=\"https:\/\/www1.wfh.org\/docs\/en\/Resources\/Assessment_Tools_PBAC.pdf\" target=\"blank\" rel=\"noopener\">Chart<\/a><\/p>\n<h6><em>N.B.: These scores are posted with the permission of the developers.<\/em><\/h6>\n\t\t<div data-elementor-type=\"section\" data-elementor-id=\"16077\" class=\"elementor elementor-16077\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7a5868e9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7a5868e9\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5b5c64ad\" data-id=\"5b5c64ad\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1cdcf1a0 elementor-widget elementor-widget-spacer\" data-id=\"1cdcf1a0\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-62224609 elementor-widget elementor-widget-html\" data-id=\"62224609\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\r\n\r\n\/* Style the tab *\/\r\n.popTab {\r\n  float: left;\r\n  border: 1px solid #ccc;\r\n  background-color: #f1f1f1;\r\n  width: 35%;\r\n  height: 500px;\r\n}\r\n\r\n\/* Style the buttons inside the tab *\/\r\n.popTab button {\r\n  display: block;\r\n  background-color: inherit;\r\n  color: black;\r\n  padding: 15px 10px;\r\n  width: 100%;\r\n  border: none;\r\n  border-radius: 0;\r\n  outline: none;\r\n  text-align: left;\r\n  cursor: pointer;\r\n  transition: 0.3s;\r\n  font-size: 1.3em;\r\n}\r\n\r\n\/* Change background color of buttons on hover *\/\r\n.popTab button:hover {\r\n  background-color: #ddd;\r\n}\r\n\r\n\/* Create an active\/current tablink class *\/\r\n.popTab button.active {\r\n  background-color: #ccc;\r\n  border: none!important;\r\n}\r\n\r\n\/* Style the tab content *\/\r\n.popContent {\r\n  float: left;\r\n  padding: 0px 1em;\r\n  border: 1px solid #ccc;\r\n  width: 65%;\r\n  border-left: none;\r\n  height: 500px;\r\n  overflow-y:auto;\r\n}\r\n\r\n.popContent table tr {\r\n    \/*pointer-events: none;*\/\r\n\r\n}\r\n\r\n.popContent table td {\r\n    border-top: none;\r\n    border-left: none;\r\n    border-right: none;\r\n    border-bottom: 1px solid #eee;\r\n    background-color: white!important;\r\n    padding-left: 0;\r\n}\r\n\r\n<\/style>\r\n\r\n\r\n<div class=\"popTab\">\r\n   <button class=\"popLinks active\" onclick=\"openTab(event, 'description')\">Description<\/button>    \r\n   <button class=\"popLinks\" onclick=\"openTab(event, 'utility')\">Utility<\/button>\r\n   <button class=\"popLinks\" onclick=\"openTab(event, 'administration')\">Administration<\/button>\r\n   <button class=\"popLinks\" onclick=\"openTab(event, 'psychometrics')\">Psychometrics<\/button>\r\n   <button class=\"popLinks\" onclick=\"openTab(event, 'references')\">References<\/button>\r\n \r\n  \r\n<\/div>\r\n\r\n<div id=\"description\" class=\"popContent\">\r\n  <h3>Description<\/h3>\r\n  <p>The PBAC is a simple, pictorial tool used in women with menorrhagia to assess menstrual blood loss.<\/p>\r\n\r\n  <p><strong>Contact person(s):<\/strong><br>\r\n   JM Higham: <a title=\"[GMCP] Compose a new mail to jenny.higham@imperial.ac.uk\" href=\"mailto:jenny.higham@imperial.ac.uk\" rel=\"noreferrer\">jenny.higham@imperial.ac.uk<\/a><\/p>\r\n\r\n<p class=\"\"><strong>Date of this review: <\/strong>August 25, 2013<br class=\"\"><strong>Updated:<\/strong> April  2014<\/p>\r\n\r\n<\/div>\r\n\r\n\r\n<div id=\"utility\" class=\"popContent\" style=\"display:none\">\r\n  <h3>Utility<\/h3>\r\n  \r\n  <p style=\"margin-bottom:0\"><strong>Overall utility:<\/strong><\/p>\r\n    <ul style=\"margin-bottom:2em;\">\r\n      <li>Useful in evaluating menorrhagia in the clinic setting between those with VWD versus other bleeding disorders<\/li>\r\n \t  <li>Can be used as a tool to measure response of menorrhagia to different forms of treatments<\/li>\r\n \t  <li>Also useful as a self-administered tool<\/li>\r\n    <\/ul>\r\n\r\n  <p style=\"margin-bottom:0\"><strong>Limitations:<\/strong><\/p>\r\n    <ul style=\"margin-bottom:2em;\">\r\n      <li>Requires quite a bit of time for the patient to complete, not readily assessable during a first consultation (unless pre-filled by patient)<\/li>\r\n \t  <li>Studies show that cut off of \u2265100 may not be sufficient to distinguish between those with and without a bleeding disorder<sup>8<\/sup><\/li>\r\n \t  <li>Can be considered subjective<\/li>\r\n \t<\/ul>\r\n<\/div>\r\n\r\n\r\n<div id=\"administration\" class=\"popContent\" style=\"display:none\">\r\n  <h3>Administration<\/h3>        \r\n  <ol>\r\n    <li><strong>Time to complete:<\/strong> 5\u201310 minutes<\/li>\r\n \t<li><strong>Equipment\/space required:<\/strong> Self-administered pictorial assessment; information pamphlet and scoring key<\/li>\r\n \t<li><strong>Training required:<\/strong> A pamphlet is available to explain how the chart should be completed by the patient<\/li>\r\n \t<li><strong>Cost:<\/strong> None<\/li>\r\n \t<li><strong>Scoring\/scaling\/interpretation of results:<\/strong> \r\n \t  <ul>\r\n \t   <li>Using the scales below, the total score is calculated by adding up the sum of all scores for the tampons or sanitary napkin used in the next menstrual cycle\r\n \t     <ul type=\"a\">\r\n \t       <li>For tampons: 1 for lightly stained, 5 for moderately soiled and 10 for completely saturated tampons.<\/li>\r\n           <li>For sanitary napkins: 1 for lightly stained, 5 for moderately soiled and 20 for completely saturated pads.<\/li>\r\n           <li>Clots were given a score of 1 for small and 5 for large clots.<\/li>\r\n         <\/ul>  \r\n       <\/li>\r\n       <li>Possible range of total score is completely dependent on quantitative and qualitative amount of bleeding during menstruation. Patient described range in original study was 5\u2013456.<sup>1<\/sup><\/li>\r\n \t   <li>Abnormal PBAC bleeding score (BS) \u2265100, which correlates with menorrhagia, defined as &gt;80 mL of menstrual blood loss.<sup>1<\/sup><\/li>\r\n      <\/ul>  \r\n    <\/li>\r\n\r\n  <\/ol>\r\n<\/div>\t\r\n\r\n<div id=\"psychometrics\" class=\"popContent\" style=\"display:none\">\r\n  <h3>Psychometrics<\/h3>        \r\n  \r\n  <p><strong>Psychometric properties:<\/strong><\/p>\r\n\r\n  <ol style=\"margin-bottom:1em\">\r\n    <li>Construct validity:<br>\r\n      <u>Convergent validity<\/u>\r\n      <ul>\r\n        <li>Good correlation between either physician or self-completed PBAC score and quantified menstrual blood loss (via alkaline haematin method).<sup>1<\/sup><\/li>\r\n \t    <li>14 of 34 adolescents diagnosed with menorrhagia had convergent scores on PBAC and HSC questionnaire.<sup>2<\/sup><\/li>\r\n \t    <li>In a randomized trial between thermal balloon ablation (TBA) and laparascopic supracervical hysterectomy (LSH) for menorrhagia, the mean PBAC score was similar between the two groups.<sup>4<\/sup><\/li>\r\n \t    <li>57% of females with factor VII deficiency had an abnormal PBAC score vs. 17% of controls.<sup>5<\/sup><\/li>\r\n \t    <li>Higher PBAC scores in adolescents was associated with adversely affected quality of life, also an abnormal PBAC score was likely to be associated with a perception of heavy periods.<sup>6<\/sup><\/li>\r\n      <\/ul>\r\n      \r\n      <u>Divergent validity<\/u>\r\n      <ul>\r\n        <li>In post-partum women, PBAC scores were similar between women who had a known bleeding disorder and those who did not.<sup>7<\/sup><\/li>\r\n      <\/ul>\r\n      \r\n      <u>Group differences<\/u>\r\n      <ul>\r\n        <li>PBAC scores were significantly higher in women with an inherited bleeding disorder than controls, however a cut-off of \u2265185 was not sufficient to statistically differentiate between affected and controls. It did however differentiate between VWD and other bleeding disorders\/controls.<sup>8<\/sup><\/li>\r\n      <\/ul>\r\n    <\/li>\r\n    \r\n \t<li>Criterion validity:\r\n \t  <ul>\r\n \t    <li>Increasing PBAC was well correlated with quantified menstrual blood loss.<sup>1<\/sup><\/li>\r\n \t <\/ul>\r\n \t<li>Reliability:\r\n \t  <ul>\r\n \t    <li>Reasonable agreement between physician-assessed and patient-assessed PBAC scores.<sup>1<\/sup><\/li>\r\n \t  <\/ul> \r\n \t<li>Responsiveness\/sensitivity:\r\n \t<ul>\r\n \t  <li>Sensitivity for a diagnosis of menorrhagia (estimated blood loss &gt;80mL) was 86% and specificity 89% when self-assessed. When assessed by a physician, sensitivity was 86% and specificity 81%.<sup>1<\/sup><\/li>\r\n \t<li>Responsiveness was shown in women undergoing endometrial ablation for menorrhagia whereby the median PBAC scores decreased from 1208 to 0 post-operatively in one study and from &gt;150 to &lt;100 in 91.5% in another study.<sup>3,9<\/sup><\/li>\r\n \t<li>Responsiveness to LSH vs. TBA post-operatively showed that the mean PBAC score was significantly lower for both procedures, but that over time the low PBAC score was more consistent post-LSH<sup>4<\/sup><\/li>\r\n \t<li>Responsiveness was shown when using DDAVP (desmopressin) or oral contraception or tranexamic acid for menorrhagia, with an expected significant decrease in PBAC score post treatment.<sup>10,11,12<\/sup> However, in another study when compared to placebo, no statistical difference was found, but this study had a very small sample size.<sup>13<\/sup><\/li>\r\n \t<li>Responsiveness was also shown to insertion of a levonorgestrel intra-uterine device (IUD) in two studies, and to oral ormeloxifene in another study, with a significant reduction in PBAC score pre- and post-placement to normal values.<sup>14,15,16<\/sup><\/li>\r\n    <\/ul>\r\n    <\/li>\r\n  <\/ol>\r\n  \r\n  <p><strong>Languages studied:<\/strong> Because the PBAC is in the form of pictures, no specific languages were studied.<\/p>\r\n \r\n  <p><strong>Groups tested:<\/strong><\/p>\r\n  <ul style=\"margin-bottom: 2em\">\r\n \t<li>Controls<\/li>\r\n \t<li>Women taking part in a separate menstrual blood loss trial<sup>1<\/sup><\/li>\r\n \t<li>Adolescent schoolgirls who self-identified as having heavy menses<sup>2,6<\/sup><\/li>\r\n \t<li>Women with and without inherited bleeding disorders and menorrhagia<sup>3,4,8,9,10,12-16<\/sup><\/li>\r\n \t<li>Post-partum women with and without bleeding disorders<sup>7<\/sup><\/li>\r\n \t<li>Adolescents with VWD<sup>11<\/sup><\/li>\r\n \t<li>Women with factor VII deficiency<sup>5<\/sup><\/li>\r\n  <\/ul>\r\n  \r\n\r\n  <p><strong>Age: <\/strong>Children and adults<\/p>\r\n  \r\n\r\n\r\n  <p><a href=\"\/resource\/glossary-of-psychometric-properties\/\" target=\"_blank\" rel=\"noopener\"><button>Glossary of Psychometric Properties<\/button><\/a><\/p>\r\n\r\n<\/div>\r\n\r\n\r\n<div id=\"references\" class=\"popContent\" style=\"display:none\">\r\n   <h3>References<\/h3>        \r\n   <ol>\r\n    <li>Higham JM et al. Assessment of menstrual blood loss using a pictorial chart. <em>Br J Obstet Gynaecol<\/em>1990; 97: 734-739.<\/li>\r\n \t<li>Revel-Vilk S et al. Underdiagnosed menorrhagia in adolescents is associated with underdiagnosed anemia. <em>J Pediatr<\/em> 2012; 160: 468-472.<\/li>\r\n \t<li>Huq FY et al. The outcome of endometrial ablation in women with inherited bleeding disorders.<em>Haemophilia<\/em> 2012; 18: 413-420.<\/li>\r\n \t<li>Sesti F et al. Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: A randomized study <em>J. Obstet. Gynaecol. Res.<\/em> 2011; 37: 1650-1657.<\/li>\r\n \t<li>Kulkarni A et al. Disorders of menstruation and their effect on the quality of life in women with congenital factor VII deficiency. <em>Haemophilia<\/em> 2006; 12: 248-252.<\/li>\r\n \t<li>Pawar A et al. Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders. <em>Haemophilia<\/em> 2008; 14, 579-583.<\/li>\r\n \t<li>Chi C, et al. Puerperal loss (lochia) in women with or without inherited bleeding disorders. <em>Am J Obstet Gynecol<\/em> 2010; 203: 56.e1-5.<\/li>\r\n \t<li>Siboni SM et al. Gynaecological and obstetrical problems in women with different bleeding disorders.<em>Haemophilia<\/em> 2009; 15: 1291-1299.<\/li>\r\n \t<li>Busund B et al. Endometrial ablation with NovaSureTM GEA, a pilot study. <em>Acta Obstet Gynecol Scand<\/em>2003; 82: 65-68.<\/li>\r\n \t<li>Mercorio F et al. Effectiveness and mechanism of action of desmopressin in the treatment of copper intrauterine device-related menorrhagia: a pilot study. <em>HumReprod<\/em> 2003; 18: 2319-2322.<\/li>\r\n \t<li>Amesse ML et al. Oral contraceptives and DDAVP nasal spray: patterns of use in managing vWD-associated menorrhagia. <em>J Pediatr Hematol Oncol<\/em> 2005; 27: 357-363.<\/li>\r\n \t<li>Kouides PA et al. Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid. <em>Br J Haematol<\/em>2009; 145: 212-220.<\/li>\r\n \t<li>Kadir RA et al. DDAVP nasal spray for treatment of menorrhagia in women with inherited bleeding disorders: a randomized placebo-controlled crossover study. <em>Haemophilia<\/em> 2002; 8: 787-793.<\/li>\r\n \t<li>Cho S et al. Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis. <em>Am J Obstet Gynecol<\/em> 2008; 198: 373.e1-373.e377.<\/li>\r\n \t<li>Reid PC and Virtanen-Kari S Randomised comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts. <em>BJOG<\/em> 2005; 112: 1121-1125.<\/li>\r\n \t<li>Kriplani A et al. Efficacy and safety of ormeloxifene in management of menorrhagia: A pilot study. <em>J Obstet Gynaecol Res<\/em> 2009; 35: 746-752.<\/li>\r\n<\/ol>\r\n\r\n<\/div>\r\n\r\n\r\n\r\n\r\n<script>\r\nfunction openTab(evt, country) {\r\n  var i, popContent, popLinks;\r\n  popContent = document.getElementsByClassName(\"popContent\");\r\n  for (i = 0; i < popContent.length; i++) {\r\n    popContent[i].style.display = \"none\";\r\n  }\r\n  popLinks = document.getElementsByClassName(\"popLinks\");\r\n  for (i = 0; i < popLinks.length; i++) {\r\n    popLinks[i].className = popLinks[i].className.replace(\" active\", \"\");\r\n  }\r\n  document.getElementById(country).style.display = \"block\";\r\n  evt.currentTarget.className += \" active\";\r\n}\r\n<\/script>\r\n   \t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-589ece4e elementor-widget elementor-widget-spacer\" data-id=\"589ece4e\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t\n","protected":false},"featured_media":23252,"template":"","format":[],"old-keyword":[],"topic":[3994],"serie":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.4 - 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