On quantifying menstrual blood loss

CONTRACEPTION

ON

QUANTIFYING S.

MENSTRUAL

T. Show,

Jr.,

BLOOD

LOSS

M.D.

The measurement of menstrual blood loss (MBL) hos been used extensively in recent years, particularly to evaluate uterine blood loss associated with Numerous methods have been devised various intrauterine contraceptives. to quantify menstrual blood loss. These include calorimetric measurements of acid hematin, alkaline hemotin, and iron, as well as radioisotope measurement of Fe-59 lobelled hemoglobin or Cr-51 labelled red cells (1). The calorimetric procedures avoid lobelling red cells with Cr-51 or red cell hemoglobin with Fe-59, but require extraction of menstrual red cell hemoglobin from sanitary materials and conversion of the hemoglobin to a substance which can be meosured photometrically. Among calorimetric procedures, the alkaline hematin method of Hallberg and Nillson (2) remoins the most popular. Although the procedures measuring extmcted hemoglobin iron are very sensitive and accurate (3, 4), the necessary chemical digestion and oxidation of sanitary materials is very time-consuming and tedious. The Hallberg and Nillson procedure requires only thot menstrual blood hemoglobin in sanitary materials are simultaneously extmcted in and converted by 5% aqueous sodium hydroxide to alkaline hematin and the latter, which is brown in color, is measured photometrically. Few if any substances which are likely to contaminate menstrual blood interfere with hemoglobin extmction, conversion, and meosurement of the alkaline hematin (5, 6). The extraction, conversion, and calorimetric measurement are all quite stmightforward procedures requiring no elaborate technics or expensive equipment. A simple colorimeter.may suffice as the only necessary piece of equipment. Shaw, Aaronson, and Moyer (5) advised high speed centrifugotion of any extmcted sanitary materials in sodium hydroxide solution which exhibited turbidity. However, such solutions are in fact more accumtely cleared by simple paper filtmtion. High speed centrifugation was discovered by these outhors to lead to underestimations in a significant number of patient samples in which alkaline hemotin color was concentrated in the centrifuged pellet. Subsequent evaluation of various filter papers demonstrated thot turbidity could be satisfactorily and conveniently removed from all extmcted samples by simple filtration through Whatman No. 4 paper. Thus, the alkaline hematin procedure published earlier in this iournal by Shaw and co-workers (5) should be changed to reflect this method of clearing turbid menstrual eluates. The two major drawbacks of the alkaline hematin procedure have been (a) the unpleasant odor produced when sodium hydroxide solution and soiled menstrual tampons or napkins are mixed, and (b) the necessity of manually or massaging these materials until their contained pummeling, agitating,

SEPTEMBER 1977 VOL. 16 NO. 3

283

CONTRACEPTION

hemoglobin

is eluted

Although

and

conversion

of menstrual and/or

hemoglobin

napkins

are

may

and stabilizes

of milliliters

of peripheml

menstrual

blood

to that

sample

mixed

almost

immediately,

as hemoglobin

require

on hour

with

mpidly

changing

blood

and

different

menstrual times,

photometric

personnel

able

period

analyses

appearing

were

to the

elsewhere

plastic found

in this

bags.

when

minutes

StomocherTM, tally

the

and the

procedure

would

method.

Although

284

to

blood

the

seem to overcome accumte

blender

labs measuring

labora-

for o consider-

Barnard,

a mechanical sanitary

conversion

before

exposes

device materials

of menstrual

perform-

and

Collins

(the

Stoma-

inside

hemoglobin

In all situations tested the 5 minutes. Under these conditions, the authors 15 minutes.

corresponding

highly

and

within

samples

extraction

thereafter,

use of an automatic advantages

within

peripheral

at uncontrollably

in a labomtory

Newton,

Thus,

in peripheral

solutions

burden

by

extmcts

and

complete

following

immediately

automatically

The extmction

to be nearly was complete

30

The paper

it is absorbed.

to stabilize

result

extracting

is converted gmdually

is present.

hematin

of

blood

and

which

is formed

in terms

intensity

is converted

must be allowed

issue (7) describes

) which

found after

week.

hours after

color

into

of alkaline

of the

tampons

of MBL

pad material

the analytical

odor

first

no extmction

hematin

or elution

when

a peripheral

materials

This imposes a significant

extraction that

the

samples

This delays

each

Lab-BlenderTM

in which

of the

the

sample

if considerable

intensities

unpleasant

of time.

ing several

sealed

color

measurement.

tory

cher

samples

the

requires

sanitary

labor

hematin

However, blood

from the color

during

menstrual

or more

and

must be a&ompIished

comparing

blood.

hematin.

extraction

Quantification

hydroxide

the

is extracted

This may the

sodium

whereas

changes

24 hours.

requires

time

procedure

of hematin

of peripheral

in aqueous

the

to brown

complete

considerable

at about blood

solution

the

rapid,

and when

intensity

its formation

by the alkaline

is very

require

numerous

The color

manually.

converted

to hematin

of the

were soiled

menstrual

MBL

samples

results

were

major

drawbacks

the

results are

such as the numerous

measured tampons

menstrual

of the with

pads in the

measured

satisfactorily

possibk

Stomacher

were

photometrically and

photomet& This

accurate. alkaline

manual

hematin

extraction,

seems to offer

significant

samples.

SEPTEMBER 1977

VOL. 16 NO. 3

CONTRACEPTION REFERENCES 1.

Shaw,

S.

T.,

Jr.

Quantitation

of

menstrual

Medicine

53~204,

2.

Hallberg, Scan. J.

Determination L. ond Nillsnn, L. Clin. Lob. Invest. 16:244, 1964.

3.

Barer, ation.

4.

Thomas, J. D. R. Med. 3:311, 1970.

5.

Shaw,

A. P. and Fowler, W. M. Am. J. Clbstet. Gynecol.

5.

T.,

Jr.,

of menstrual

blood

Contraception 6.

Poon,

C.

H.,

on menstrual Med. 7.

Prim.

Newton,

J.,

Aaronson,

37:979,

D.

loss - further 1972.

Moyer,

D.

2:353,

loss.

Postgmduote

L.,

E.,

loss during

of menstrual

iron

and Moyer,

D.

Forino,

R.

blnnd

nnrmal

loss.

menstru-

1936.

evaluation

loss in intact

nf menstrual

The blood

The determination

5~497,

blood

blood

1973.

loss.

L.

Quantitation

of the alkaline

V.

and Shaw,

ond experimental

Biochem.

hemotin

S.

T.

method.

Studies

rhesus monkeys.

J.

197’3.

Barnard,

G.,

and Williams,

menstrual blood loss using automatic

C.

extraction.

A mpid method for measuring Contraception

16:269,

1977.

S. T. Shaw, Jr., M.D. Department of Pathology University of Southern California School of Medicine Livingston Research Center 1321 North Mission Road Los Angeles, Calif. 90033

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