Perl's config says that U32 access must be aligned.
Checking if your kit is complete...
Looks good
Writing Makefile for Digest::MD5::M4p

Microsoft (R) Program Maintenance Utility   Version 6.00.8168.0
Copyright (C) Microsoft Corp 1988-1998. All rights reserved.

cp M4p.pm blib\lib\Digest\MD5\M4p.pm
	C:\cpanrun\build\5-10-0\bin\perl.exe C:\cpanrun\build\5-10-0\lib\ExtUtils\xsubpp  -typemap C:\cpanrun\build\5-10-0\lib\ExtUtils\typemap -typemap typemap  M4p.xs > M4p.xsc && C:\cpanrun\build\5-10-0\bin\perl.exe -MExtUtils::Command -e mv M4p.xsc M4p.c
	cl -c    -nologo -GF -W3 -MD -Zi -DNDEBUG -O1 -DWIN32 -D_CONSOLE -DNO_STRICT -DHAVE_DES_FCRYPT -DUSE_SITECUSTOMIZE -DPRIVLIB_LAST_IN_INC -DPERL_IMPLICIT_CONTEXT -DPERL_IMPLICIT_SYS -DUSE_PERLIO -DPERL_MSVCRT_READFIX -MD -Zi -DNDEBUG -O1    -DVERSION=\"0.01\"  -DXS_VERSION=\"0.01\"  "-IC:\cpanrun\build\5-10-0\lib\CORE"  -DU32_ALIGNMENT_REQUIRED M4p.c
M4p.c
M4p.xs(607) : warning C4090: 'initializing' : different 'const' qualifiers
M4p.xs(610) : warning C4101: 'my_na' : unreferenced local variable
Running Mkbootstrap for Digest::MD5::M4p ()
	C:\cpanrun\build\5-10-0\bin\perl.exe -MExtUtils::Command -e chmod 644 M4p.bs
	C:\cpanrun\build\5-10-0\bin\perl.exe -MExtUtils::Mksymlists  -e "Mksymlists('NAME'=>\"Digest::MD5::M4p\", 'DLBASE' => 'M4p', 'DL_FUNCS' => {  }, 'FUNCLIST' => [], 'IMPORTS' => {  }, 'DL_VARS' => []);"
	link -out:blib\arch\auto\Digest\MD5\M4p\M4p.dll -dll -nologo -nodefaultlib -debug -opt:ref,icf  -libpath:"C:\cpanrun\build\5-10-0\lib\CORE"  -machine:x86 M4p.obj   C:\cpanrun\build\5-10-0\lib\CORE\perl510.lib oldnames.lib kernel32.lib user32.lib gdi32.lib winspool.lib  comdlg32.lib advapi32.lib shell32.lib ole32.lib oleaut32.lib  netapi32.lib uuid.lib ws2_32.lib mpr.lib winmm.lib  version.lib odbc32.lib odbccp32.lib msvcrt.lib -def:M4p.def
   Creating library blib\arch\auto\Digest\MD5\M4p\M4p.lib and object blib\arch\auto\Digest\MD5\M4p\M4p.exp
	C:\cpanrun\build\5-10-0\bin\perl.exe -MExtUtils::Command -e chmod 755 blib\arch\auto\Digest\MD5\M4p\M4p.dll
	C:\cpanrun\build\5-10-0\bin\perl.exe -MExtUtils::Command -e cp M4p.bs blib\arch\auto\Digest\MD5\M4p\M4p.bs
	C:\cpanrun\build\5-10-0\bin\perl.exe -MExtUtils::Command -e chmod 644 blib\arch\auto\Digest\MD5\M4p\M4p.bs

Microsoft (R) Program Maintenance Utility   Version 6.00.8168.0
Copyright (C) Microsoft Corp 1988-1998. All rights reserved.

	C:\cpanrun\build\5-10-0\bin\perl.exe "-MExtUtils::Command::MM" "-e" "test_harness(1, 'blib\lib', 'blib\arch')" t/*.t
t/01_test....1..7
ok 1 - use Digest::MD5::M4p;
ok 2 - The object isa Digest::MD5::M4p
ok 3 - Clone
ok 4 - add
ok 5 - nop
ok 6 - add again
ok 7 - and again
ok
All tests successful.
Files=1, Tests=7,  1 wallclock secs ( 0.00 cusr +  0.00 csys =  0.00 CPU)

Microsoft (R) Program Maintenance Utility   Version 6.00.8168.0
Copyright (C) Microsoft Corp 1988-1998. All rights reserved.

Files found in blib\arch: installing files in blib\lib into architecture dependent library tree
Installing C:\cpanrun\build\5-10-0\lib\auto\Digest\MD5\M4p\M4p.bs
Installing C:\cpanrun\build\5-10-0\lib\auto\Digest\MD5\M4p\M4p.dll
Installing C:\cpanrun\build\5-10-0\lib\auto\Digest\MD5\M4p\M4p.exp
Installing C:\cpanrun\build\5-10-0\lib\auto\Digest\MD5\M4p\M4p.lib
Installing C:\cpanrun\build\5-10-0\lib\auto\Digest\MD5\M4p\M4p.pdb
Installing C:\cpanrun\build\5-10-0\html\lib\Digest\MD5\M4p.html
Installing C:\cpanrun\build\5-10-0\lib\Digest\MD5\M4p.pm
Appending installation info to C:\cpanrun\build\5-10-0\lib/perllocal.pod