Evaluation of CBC Parameters in Women with Abnormal Uterine Bleeding to Predict Risk of Underlying Endometrial Carcinoma

Abstract

Background: Abnormal uterine bleeding (AUB) is a common gynecological issue. While the majority of cases are benign, up to 10% are due to endometrial carcinoma (EC). Complete blood count (CBC) parameters, particularly hemoglobin (Hb), mean corpuscular volume (MCV), red cell distribution width (RDW), and platelet indices, have emerged as promising, readily available biomarkers for early EC detection.

Objective: To see if specific CBC parameters can predict the presence of underlying endometrial carcinoma in women presenting with AUB.

Methods: In this single-center, cross-sectional study at DHQ Hospital Jhelum (Jan-Jun 2025), we enrolled 100 women aged ?35 with AUB. Within 24 hours of presentation, all patients received transvaginal ultrasound, endometrial sampling, and a complete blood count. Patients were classified as EC (n = 20) or non-EC (n = 80) based on histopathology. We compared Hb, MCV, RDW, platelet count (PLT), and platelet-to-lymphocyte ratio (PLR). The optimal cut-offs were determined using a receiver operating characteristic curve (ROC) analysis.

Results: The EC group showed significantly lower mean Hb (10.2 ± 1.5 vs. 11.6 ± 1.2 g/dL, p < 0.001), higher RDW (15.1 ± 1.2% vs. 13.4 ± 1.0%, p < 0.001), and PLR (185 ± 40 vs. 130 ± 35, p < 0.001). MCV and PLT were not significantly different. In ROC analysis, RDW > 14.2% predicted EC with 85% sensitivity and 80% specificity (AUC 0.88, 95% CI 0.79-0.97), while Hb < 10.8 g/dL had AUC 0.81 (95% CI 0.70-0.92) [1-3].

Conclusion: Elevated RDW and decreased Hb are independent predictors of EC in AUB. Routine CBC may help with triage and prioritization for endometrial sampling, especially in resource-limited settings.