Studies on Erythrocyte Sedimentation Rate, Serum Iron / Total Iron Binding Capacity, and Progesterone in Women with Uterine Fibroid in Imo State

• Authors: Akubuo Chigaemezu Remmy-Martin , Okorocha Odinaka Bright , Ofoegbu Chigemezu Destiny , Onwuegbuchu Juliet Chinelo , Ofodu Chukwumali Maxwell
• Languages of publication: EN

Abstracts

EN

Uterine fibroids are the most common benign tumors of the female reproductive tract and are frequently associated with heavy menstrual bleeding, inflammation, and hormonal dysregulation. These features predispose affected women to iron deficiency and related hematological alterations. However, data integrating inflammatory markers, iron indices, and progesterone levels in women with uterine fibroid in South-Eastern Nigeria remain limited. This study evaluated erythrocyte sedimentation rate (ESR), serum iron, total iron-binding capacity (TIBC), transferrin saturation, and serum progesterone levels in women diagnosed with uterine fibroid in Imo State, Nigeria. This analytical cross-sectional study included 30 women with ultrasound-confirmed uterine fibroid and 30 age-matched apparently healthy controls. ESR was determined using the Westergren method, serum iron and TIBC were measured colorimetrically, transferrin saturation was calculated, and serum progesterone was assayed using ELISA. Data were analyzed using independent sample t-tests, one-way ANOVA, correlation analysis, and effect size estimation. Statistical significance was set at p < 0.05. Women with uterine fibroid had significantly higher ESR compared with controls (70.37 ±36.53 vs 10.93 ±9.52 mm/hr; p < 0.0001). Serum iron levels were significantly reduced in the fibroid group (12.05 ±4.14 vs 27.78 ±9.53 µmol/L; p < 0.0001), while TIBC was significantly elevated (153.33 ±77.51 vs 71.54 ±26.03 µmol/L; p < 0.0001). Mean transferrin saturation was markedly lower among women with fibroid (10.08%) compared with controls (45.23%), with 86.7% of fibroid patients exhibiting transferrin saturation <20%. Serum progesterone levels were significantly higher in the fibroid group (31.44 ±20.47 vs 6.18 ±7.15 ng/mL; p < 0.0001). Effect size analysis demonstrated very large differences for ESR (Cohen’s d = 2.23) and serum iron (d = −2.14). Age-stratified analysis showed no significant differences across age groups for ESR, iron indices, or progesterone (p > 0.05). Women with uterine fibroid in Imo State exhibit significant inflammatory activity, profound iron deficiency, and elevated progesterone levels compared with healthy controls. The high prevalence of reduced transferrin saturation highlights the clinical importance of routine iron status assessment in fibroid management. These findings underscore the need for integrated inflammatory, hematological, and hormonal evaluation in women with uterine fibroid, particularly in resource-limited settings.

Keywords

EN

Uterine fibroid; erythrocyte sedimentation rate; iron deficiency; progesterone; transferrin saturation

Discipline

• BIOCHEMISTRY: BIOCHEMISTRY

• Publisher: Scientific Publishing House „DARWIN”
• Journal: World News of Natural Sciences
• Year: 2026
• Volume: 64
• Pages: 316-333

Contributors

author

Akubuo Chigaemezu Remmy-Martin

• Department of Microbiology, Imo State University, Owerri, Imo State, Nigeria

author

Okorocha Odinaka Bright

• Department of Medicine and Surgery, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria

author

Ofoegbu Chigemezu Destiny

• Department of Biochemistry, Imo State University Owerri, Imo State, Nigeria

author

Onwuegbuchu Juliet Chinelo

• Department of Medicine and Surgery, Imo State University, Orlu Campus, Imo State, Nigeria

author

Ofodu Chukwumali Maxwell

• Department of Medicine and Surgery, Imo State University, Orlu Campus, Imo State, Nigeria

References

• [1] Abbaspour, N., Hurrell, R., and Kelishadi, R. (2014). Review on iron and its importance for human health. Nutrients, 6(2): 616–633
• [2] American College of Obstetricians and Gynecologists. (2021). Management of symptomatic uterine leiomyomas: ACOG Practice Bulletin No. 228. Obstetrics and Gynecology, 137(6): e100-e115
• [3] Ali, M., Ciebiera, M., Vafaei, S., Alkhrait, S., Chen, H. Y., Chiang, Y. F., et al. (2023). Progesterone signaling and uterine fibroid pathogenesis; molecular mechanisms and potential therapeutics. Cells 12(8): 1117
• [4] Al-Naseem, A., Sallam, A., Choudhury, S., and Thachil, J. (2021). Iron deficiency without anaemia: A diagnosis that matters. Clinical Medicine, 21(2): 107-113
• [5] Andrews, P. A. (2000). Disorders of iron metabolism. The New England Journal of Medicine, 342(17): 1293-1294
• [6] Brigden, M. L. (1999). Clinical utility of the erythrocyte sedimentation rate. American Family Physician, 60(5): 1443-1450
• [7] Bulun, S. E., Yin, P., and colleagues. (2025). Uterine fibroids. Physiological Reviews, 105(4): 1947-1988
• [8] Sholzberg, M., Hillis, C., Crowther, M., and Selby, R. (2025). Diagnosis and management of iron deficiency in females. CMAJ, 197(24), E680-E687
• [9] Whitehead, R. D., Jr., Mei, Z., Mapango, C. and Jefferds, M. E. D. (2019). Methods and analyzers for hemoglobin measurement in clinical laboratories and field settings. Annals of the New York Academy of Sciences, 1450(1): 147-171
• [10] Athan, S., Athan, D., Wong, M., Hussain, N., Vangaveti, V., Gangathimmaiah, V., & Norton, R. (2023). Pathology stewardship in emergency departments: a single-site, retrospective, cohort study of the value of C-reactive protein in patients with suspected sepsis. Pathology, 55(5): 673-679
• [11] Dolmans, M.-M., Petraglia, F., Catherino, W. H., and Donnez, J. (2024). Pathogenesis of uterine fibroids: Current understanding and future directions. Fertility and Sterility, 122(1): 6-11
• [12] Donnez, J., Carmona, F., Maitrot-Mantelet, L., Dolmans, M.-M., and Chapron, C. (2022). Uterine disorders and iron deficiency anemia. Fertility and Sterility, 118(4): 615-624
• [13] Donnez, J., Tatarchuk, T. F., Bouchard, P., Puscasiu, L., Zakharenko, N. F., Ivanova, T., et al. (2012). Ulipristal acetate versus placebo for fibroid treatment before surgery. New England Journal of Medicine, 366(5): 409-420
• [14] Filicori, M., Butler, J. P., and Crowley, W. F. (1984). Neuroendocrine regulation of the corpus luteum in the human. Evidence for pulsatile progesterone secretion. The Journal of Clinical Investigation, 73(6): 1638-1647
• [15] Gleason, J. L., Thoma, M. E., Zukerman Willinger, N., and Shenassa, E. D. (2022). Endometriosis and uterine fibroids and their associations with elevated C-reactive protein and leukocyte telomere length among a representative sample of US women: data from the National Health and Nutrition Examination Survey, 1999-2002. Journal of Women's Health, 31(7): 1020-1028
• [16] Goldberg, H. R., McCaffrey, C., Solnik, J., Lemos, N., Sobel, M., Kives, S., et al. (2025). High prevalence of undiagnosed iron deficiency in endometriosis patients: A cross‐sectional study. International Journal of Gynecology and Obstetrics, 168(3): 1321-1327
• [17] Handelsman, D. J. (2017). Mass spectrometry, immunoassay and valid steroid measurements in reproductive medicine and science. Human Reproduction 32(6): 1147-1150
• [18] Hands, K., Daru, J., Evans, C., Kotze, A., Lewis, C., Narayan, S., et al. (2024). Identification and management of preoperative anaemia in adults: A British Society for Haematology Guideline update. British Journal of Haematology, 205(1): 88-99
• [19] Ishikawa, H., Shozu, M., and Okada, H. (2024). Role of inflammation and immune response in the pathogenesis of uterine fibroids. Journal of Steroid Biochemistry and Molecular Biology, 246: 106438
• [20] Kim, T. K. (2015). T test as a parametric statistic. Korean Journal of Anesthesiology, 68(6), 540-546
• [21] Munro, M. G., Critchley, H. O., Broder, M. S., Fraser, I. S., (2011). FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynecology and Obstetrics, 113(1): 3-13
• [22] Munro, M. G., Lukes, A. S., and Critchley, H. O. D. (2023). Heavy menstrual bleeding, iron deficiency, and iron deficiency anemia: The under-recognized triad. International Journal of Gynecology and Obstetrics, 162(1): 3-10
• [23] Bird, C., LaBouchardiere, J., and Richardson, J. (2019). NICE Nuggets: NG88: Heavy menstrual bleeding: assessment and management. InnovAiT, 13(11): 175-573
• [24] Peyrin-Biroulet, L., Williet, N., and Cacoub, P. (2015). Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. The American Journal of Clinical Nutrition, 102(6): 1585-1594
• [25] Regidor, P. A., Mayr, M., Santos, F. G., Calvo, B. L., Gutierrez, R., and Rizo, J. M. (2025). Narrative Review of Chronic Inflammation in Uterine Myoma: Lack of Specialized Pro-Resolving Lipid Mediators (SPMs) and Vitamin D as a Potential Reason for the Development of Uterine Fibroids. Biomedicines, 13(8): 1832
• [26] Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3): 261-264
• [27] Stanczyk, F. Z., Cho, M. M., Endres, D. B., Morrison, J. L., Patel, S., and Paulson, R. J. (2003). Limitations of direct estradiol and testosterone immunoassay kits. Steroids, 68(14): 1173-1178
• [28] Kratz, A., Plebani, M., Peng, M., Lee, Y. K., McCafferty, R., & Machin, S. J. (2017). ICSH recommendations for modified and alternate methods measuring the erythrocyte sedimentation rate. International Journal of Laboratory Hematology, 39(5): 448-457
• [29] Uimari, O., Subramaniam, K. S., Vollenhoven, B., andTapmeier, T. T. (2022). Uterine fibroids (Leiomyomata) and heavy menstrual bleeding. Frontiers in Reproductive Health, 4: 818243
• [30] Westergren, A. (1921). Studies of the Suspension Stability of the Blood. Acta Medica Scandinavica, 54: 247
• [31] World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310(20): 2191-2194
• [32] Yang, Q., Ciebiera, M., Bariani, M. V., Ali, M., Elkafas, H., Boyer, T. G., and Al-Hendy, A. (2022). Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment. Endocrine Reviews, 43(4): 678-719

• Document Type: article