Spot of blood, blood is a repeated motif of guilt in the play, symbolising guilt. At this point in the play, Lady Macbeth's mental state is declining because of her guilt. - Imperative 'out' shows the downfall of her mental state as she orders a spot of blood. - 'damned' connotes sin and implies that she is accursed to hell because of her sin, Shakespeare presents all her efforts to rid the 'damned spot' as a futile endeavour. - Ironic and painful reversal of her earlier claim 'a little water clears us of this deed'