[vc_row][vc_column][mpc_button preset=”mpc_preset_42″ url=”url:https%3A%2F%2Felearning.wfh.org%2Fresource%2Fcompendium-outils-evaluation%2F%23outils_evaluation_saignements|title:Compendium%20of%20Assessment%20Tools||” font_preset=”preset_0″ font_color=”#e31837″ font_size=”20″ font_transform=”uppercase” title=”REVENIR” icon=”fa fa-arrow-left” icon_color=”#616265″ icon_size=”20″ icon_effect=”stay-left” icon_gap=”10″ border_divider=”true” border_css=”border-radius:0px;” padding_divider=”true” padding_css=”padding-top:0px;padding-right:30px;padding-bottom:0px;padding-left:0px;” margin_divider=”true” margin_css=”margin-top:0px;” hover_font_color=”#008bb0″ hover_icon_color=”#616265″ hover_background_effect=”expand-diagonal_left” hover_background_offset=”110″ hover_border_css=”border-width:0px;border-color:0;border-radius:0px;” mpc_tooltip__disable=”true”][vc_column_text]

Pictorial Blood Loss Assessment Chart (PBAC)

Authors/developers
Higham JM, O’Brien PMS, Shaw RW

Chart

N.B.: These scores are posted with the permission of the developers.

[/vc_column_text][mpc_tabs preset=”mpc_preset_11″ tabs_position=”left” active_tab=”0″ decor_line=”true” decor_color=”#616265″ decor_active=”#616265″ decor_size=”2″ decor_gap=”10″ font_preset=”preset_0″ font_color=”#888888″ font_size=”14″ font_line_height=”1.75″ font_align=”left” content_padding_divider=”true” content_padding_css=”padding-top:20px;padding-right:0px;padding-bottom:10px;padding-left:0px;” background_color=”#f7f7f7″ padding_css=”padding:30px;” margin_divider=”true” margin_css=”margin-right:10px;margin-left:20px;” mpc_button__font_preset=”preset_1″ mpc_button__font_color=”#e31837″ mpc_button__font_size=”16″ mpc_button__font_transform=”none” mpc_button__font_align=”left” mpc_button__border_divider=”true” mpc_button__border_css=”border-radius:15px;” mpc_button__padding_divider=”true” mpc_button__padding_css=”padding-right:20px;padding-left:20px;” mpc_button__hover_font_color=”#ffffff” mpc_button__hover_background_color=”#008bb0″ mpc_button__hover_background_effect=”expand-horizontal” mpc_button__hover_border_divider=”true” mpc_button__hover_border_css=”border-radius:0px;” button_margin_divider=”true” button_margin_css=”margin-right:0px;margin-left:0px;”][mpc_tab title=”Description” tab_id=”1468785295-1-20b60e-72e13c95-2e8a6109-b79c”][vc_column_text css=”.vc_custom_1486397289767{margin-left: 0px !important;border-left-width: 0px !important;padding-left: 20px !important;}”]The PBAC is a simple, pictorial tool used in women with menorrhagia to assess menstrual blood loss.

Contact person:
JM Higham: [email protected]

Date of this review: August 25, 2013
Updated: April, 2014[/vc_column_text][/mpc_tab][mpc_tab title=”Utility” tab_id=”1468785295-2-99b60e-72e13c95-2e8a6109-b79c”][vc_column_text css=”.vc_custom_1475159515397{padding-left: 20px !important;}” el_class=”arrow”]Overall utility:

• Useful in evaluating menorrhagia in the clinic setting between those with VWD versus other bleeding disorders
• Can be used as a tool to measure response of menorrhagia to different forms of treatments
• Also useful as a self-administered tool

Limitations:

• Requires quite a bit of time for the patient to complete, not readily assessable during a first consultation (unless pre-filled by patient)
• Studies show that cut off of ≥100 may not be sufficient to distinguish between those with and without a bleeding disorder⁸
• Can be considered subjective

[/vc_column_text][/mpc_tab][mpc_tab title=”Administration” tab_id=”1468785421664-2-2b60e-72e13c95-2e8a6109-b79c”][vc_column_text css=”.vc_custom_1475160508572{padding-top: 5px !important;padding-bottom: 5px !important;padding-left: 20px !important;}” el_class=”arrow”]1.  Time to complete: Not identified

2.  Equipment/space required: Self-administered pictorial assessment; information pamphlet and scoring key

3.  Training required: A pamphlet is available to explain how the chart should be completed by the patient

4.  Cost: None

5.  Scoring/scaling/interpretation of results:

• 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

– For tampons: 1 for lightly stained, 5 for moderately soiled and 10 for completely saturated tampons.
– For sanitary napkins: 1 for lightly stained, 5 for moderately soiled and 20 for completely saturated pads.
– Clots were given a score of 1 for small and 5 for large clots.

• Possible range of total score is completely dependent on quantitative and qualitative amount of bleeding during menstruation. Patient described range in original study was 5–456.¹
• Abnormal PBAC bleeding score (BS) ≥100, which correlates with menorrhagia, defined as >80 mL of menstrual blood loss.¹

[/vc_column_text][/mpc_tab][mpc_tab title=”Psychometrics” tab_id=”1468785430492-3-3b60e-72e13c95-2e8a6109-b79c”][vc_column_text css=”.vc_custom_1475161301438{padding-left: 20px !important;}” el_class=”arrow”]Psychometric properties:

1.  Construct validity:

Convergent validity

• Good correlation between either physician or self-completed PBAC score and quantified menstrual blood loss (via alkaline haematin method).¹
• 14 of 34 adolescents diagnosed with menorrhagia had convergent scores on PBAC and HSC questionnaire.²
• 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.⁴
• 57% of females with factor VII deficiency had an abnormal PBAC score vs. 17% of controls.⁵
• 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.⁶

Divergent validity

• In post-partum women, PBAC scores were similar between women who had a known bleeding disorder and those who did not.⁷

Group differences

• PBAC scores were significantly higher in women with an inherited bleeding disorder than controls, however a cut-off of ≥185 was not sufficient to statistically differentiate between affected and controls. It did however differentiate between VWD and other bleeding disorders/controls.⁸

2.  Criterion validity:

• Increasing PBAC was well correlated with quantified menstrual blood loss.¹

3.  Reliability:

• Reasonable agreement between physician-assessed and patient-assessed PBAC scores.¹

4.  Responsiveness/sensitivity:

• Sensitivity for a diagnosis of menorrhagia (estimated blood loss >80mL) was 86% and specificity 89% when self-assessed. When assessed by a physician, sensitivity was 86% and specificity 81%.¹
• 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 >150 to <100 in 91.5% in another study.^3,9
• 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-LSH⁴
• 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.^10,11,12 However, in another study when compared to placebo, no statistical difference was found, but this study had a very small sample size.¹³
• 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.^14,15,16

Languages studied: Because the PBAC is in the form of pictures, no specific languages were studied.

Groups tested:

• Controls
• Women taking part in a separate menstrual blood loss trial¹
• Adolescent schoolgirls who self-identified as having heavy menses^2,6
• Women with and without inherited bleeding disorders and menorrhagia^{3,4,8,9,10,12-16}
• Post-partum women with and without bleeding disorders⁷
• Adolescents with VWD¹¹
• Women with factor VII deficiency⁵

Age: Children and adults

[/vc_column_text][/mpc_tab][mpc_tab title=”References” tab_id=”1468785442046-4-10b60e-72e13c95-2e8a6109-b79c”][vc_column_text css=”.vc_custom_1468894147582{padding-left: 20px !important;}”]

1. Higham JM et al. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol1990; 97: 734-739.
2. Revel-Vilk S et al. Underdiagnosed menorrhagia in adolescents is associated with underdiagnosed anemia. J Pediatr 2012; 160: 468-472.
3. Huq FY et al. The outcome of endometrial ablation in women with inherited bleeding disorders.Haemophilia 2012; 18: 413-420.
4. Sesti F et al. Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: A randomized study J. Obstet. Gynaecol. Res. 2011; 37: 1650-1657.
5. Kulkarni A et al. Disorders of menstruation and their effect on the quality of life in women with congenital factor VII deficiency. Haemophilia 2006; 12: 248-252.
6. Pawar A et al. Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders. Haemophilia 2008; 14, 579-583.
7. Chi C, et al. Puerperal loss (lochia) in women with or without inherited bleeding disorders. Am J Obstet Gynecol 2010; 203: 56.e1-5.
8. Siboni SM et al. Gynaecological and obstetrical problems in women with different bleeding disorders.Haemophilia 2009; 15: 1291-1299.
9. Busund B et al. Endometrial ablation with NovaSureTM GEA, a pilot study. Acta Obstet Gynecol Scand2003; 82: 65-68.
10. Mercorio F et al. Effectiveness and mechanism of action of desmopressin in the treatment of copper intrauterine device-related menorrhagia: a pilot study. HumReprod 2003; 18: 2319-2322.
11. Amesse ML et al. Oral contraceptives and DDAVP nasal spray: patterns of use in managing vWD-associated menorrhagia. J Pediatr Hematol Oncol 2005; 27: 357-363.
12. Kouides PA et al. Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid. Br J Haematol2009; 145: 212-220.
13. Kadir RA et al. DDAVP nasal spray for treatment of menorrhagia in women with inherited bleeding disorders: a randomized placebo-controlled crossover study. Haemophilia 2002; 8: 787-793.
14. Cho S et al. Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis. Am J Obstet Gynecol 2008; 198: 373.e1-373.e377.
15. 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. BJOG 2005; 112: 1121-1125.
16. Kriplani A et al. Efficacy and safety of ormeloxifene in management of menorrhagia: A pilot study. J Obstet Gynaecol Res 2009; 35: 746-752.

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