title: Pictorial blood loss assessment chart in the evaluation of heavy menstrual bleeding: diagnostic accuracy compared to alkaline hematin.
abstract: OBJECTIVE
  The pictorial blood assessment chart (PBAC) is a method for evaluation of menstrual blood loss (MBL). This study was conducted to evaluate the accuracy of the PBAC score in diagnosing MBL compared to alkaline hematin as a gold standard.
  
  
  METHODS
  Two cohorts were constructed: 30 women who reported 'normal' menses and 170 who reported 'heavy' menses. Evaluation of menstruation was performed using the PBAC score and by alkaline hematin.
  
  
  RESULTS
  Women who reported normal menses were younger (p = 0.071), had lower parity [median parity of 3 (range 1-6) vs. 4 (range 1-12), p < 0.001] and higher hemoglobin levels (11.1 ± 1.1 vs. 10.1 ± 1.6 g/dl, p < 0.001). PBAC scores and MBL by alkaline hematin were significantly correlated (Spearman r = 0.600, p < 0.001). The PBAC score of 150 had a κ of 0.593 (95% CI 0.480-0.687) and an area under the curve of 0.796 (95% CI 0.770-0.821). In a multivariable regression PBAC score >150, presence of blood clots and period duration >7 days were independent predicators of heavy menstrual bleeding with an overall area under the curve of 0.858 (95% CI 0.835-0.879).
  
  
  CONCLUSIONS
  The PBAC score is a simple and accurate tool for semiobjective of MBL that can be used in clinical practice to aid the decision about treatment and follow-up.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Mahmoud S
authors.initials: MS
authors.lastname: Zakherah
authors.forename: Gamal H
authors.initials: GH
authors.lastname: Sayed
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.forename: Mamdouh M
authors.initials: MM
authors.lastname: Shaaban
mesh_terms: D000328:Adult; D005260:Female; D005293:Ferritins / Q000097:blood; D006427:Hemin; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008595:Menorrhagia / Q000175:diagnosis* / Q000503:physiopathology*; D008875:Middle Aged; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D006427:Hemin; D005293:Ferritins