Pictorial Blood Loss Assessment Chart: How Can It Help?

Your Pictorial Blood Loss Assessment Chart: Know Your PBAC Score

The most common reason why a woman has heavy menstrual bleeding is uterine fibroids. A lot of my patients know they bleed very heavy each month, but feel that because that’s gone on awhile that it’s just “normal” for them. This is one of many factors that lead to a delay in diagnosis and subsequent treatment.

Heavy menstrual bleeding is defined by blood loss > 80 ml per menstrual cycle. While the number is definitive, it is clearly not practical for the patient. There are methods that are equally impractical for women which require the collection of all sanitary products and submitting them for laboratory analysis or even weighing them!

A somewhat more practical measure that can be helpful is the Pictoral Blood Loss Assessment Chart or PBAC.

Pictorial Blood Loss Assessment Chart: How Can It Help?

Individual pads and/or tampons are collected each day and scored based on a pictorial chart representing lightly, moderately, or heavily soaked. A number score is assigned for each of those 3 levels, as well as, additional points for large/small clots and episodes of blood flooding/gushing out. A total score of >100 is equivalent to a blood loss of >80ml/cycle.

The continued loss of this amount of blood invariably will lead to anemia. Anemia is having a low number of red blood cells. When a woman is bleeding too heavy and it is not corrected, she will become anemic. This deficit of red blood cells is accompanied by a loss of hemoglobin; the main protein of the red blood cell.

Pictorial Blood Loss Assessment Chart and Fibroids

Hemoglobin is responsible for carrying oxygen in the blood. Therefore, it is not surprising that the hallmark of anemia is being tired and fatigued. Other clinical signs of anemia include: episodes of lightheadedness/dizziness, brain fog (cloudy thinking), heart palpitations, migraine-like headaches, and chewing/craving ice.

For women with symptomatic fibroids, this deficit cannot be corrected with oral iron supplementation or iron rich foods, although it can make the woman feel somewhat better.  Occasionally, intravenous iron infusions or even blood transfusions are given, but the underlying cause of the bleeding needs to be determined and treated. For most women, it will be to fix uterine fibroids.

Fortunately, there is an outpatient, non-surgical procedure called Uterine Fibroid Embolization (UFE). It treats every fibroid in the uterus and puts an end to heavy menstrual bleeding in almost every patient. Therefore, it not only provides relief of the heavy menstrual bleeding, but these women avoid the risks and long recovery of surgery, and UFE also allows her to keep her uterus.

In addition, patients cannot be operated on with the low Hemoglobin levels that many of these patients have. It’s due to the fact that there is often very significant intraoperative bleeding during surgery. It’s the main reason patients are given iron or blood, to “tank them up” before surgery.

Unlike surgery, there is no blood loss during a UFE procedure. Therefore, UFE patients do not need pre-procedural iron or blood. This is a relief for UFE patients that are very concerned about receiving these products, as there are a number of unpleasant side effects and even allergic reactions.

For more information on heavy menstrual bleeding, fibroids, or the UFE procedure make an appointment with Dr. John Lipman of Atlanta Fibroid Center by calling 770-214-4600 or make an appointment online.


Read more