Blood on urine Microscopy

Is it Something Serious?

Few red blood cells (RBCs) can occasionally be found in the urine of healthy adults. But too many of them raise strong suspicion of an underlying disease. If your urine microscopy report shows >3 RBCs/ hpf (high power field), it is definitely not something that you can overlook. Not even if you have no other complaints or abnormal lab findings.  Your doctor can advise the next course of action after assessing your risk for serious urological diseases.

 

Most Common Causes of Microhematuria

The list of causes of microhematuria is formidably long. However, you would be relieved to know that life threatening conditions such as cancer are uncommon, particularly in those <40 years of age. And there are several benign causes that may just require you to follow-up more often with your doctor or do nothing at all.
Just to let you have a quick glance, here are the causes found in some patients having microscopic blood in urine (microhematuria) with no other abnormal lab findings or symptoms.

 

  • No detectable cause (37%)
  • Enlarged Prostate (24%)
  • Urethral Infection (21%)
  • Urinary Tract Infection (7%)
  • Kidney Stone (4%)
  • Stone in Urethra (2%)
  • Bladder Tumors (2%)
  • Cyst in Kidney (1.5%)
  • Kidney Tumors (0.5%)

Keep in mind that this is an overall data from a mixed group of all ages and varying symptoms and risk profiles. It does not really reflect the likelihood in your case.

What Could Be The Cause In My Case?

Here’s how we can broadly go about thinking of the possible causes in your case:

 

  • Let’s first think of the harmless reasons. Some common benign reasons for microhematuria are:
  • Vigorous exercise
  • Recent sexual activity
  • Viral infections
  • Sample contamination with blood from vagina/anus

Your doctor can tell from a careful history and symptoms if any of these could be the culprit. In such a case, probably he/she will ask you to get repeat urine tests done after some time on more carefully collected samples. If three tests done on different days come negative for RBC, no more investigations would be needed.

  • Urinary tract infections (UTIs): UTIs can cause microhematuria. Your doctor can tell from your urine test findings and symptoms if an infection could be the cause (WBCs, bacteria etc). You may be prescribed treatment and the urine microscopy repeated after the infection has cleared.
  • Trauma to the urinary tract: Think back if you were playing some rough sport that involved a lot of kicking and punching, or had an accident or fall few days before your urine test.  These can cause injuries in your urinary tract and cause microhematuria.
  • Kidney disease:  Kidney diseases are an important cause of microhematuria, mostly along with other important urine abnormalities such as protein in urine, deposits called casts, and deformed RBCs. If your medical history, symptoms or urine test report suggest a possibility of kidney disease, you may be referred to a nephrologist.
  • Urological Conditions: If most of the above conditions are ruled out, you may need to be evaluated by a urologist. Some important causes that he or she will look for are:
  • Stones:  Stones are a frequent cause of microhematuria in patients younger than 40 years of age. Imaging tests such as a CT scan can tell if there is a stone in the urinary system.
  • Benign prostatic hyperplasia (BPH): It is a benign (noncancerous) enlargement of the prostate gland often seen in middle aged men and often the cause of microhematuria in this age group.
  • Cancer:  Cancers more often cause frank blood in urine. Microscopic blood is less likely to be because of cancer. Bladder cancer is the most common cancer found in patients with microhematuria. A special examination of cells shed in urine (cytology) and direct visualization of the bladder (cystoscopy) are often needed to diagnose bladder cancer. Kidney and prostate cancer are also looked for using appropriate tests.
  • Any other growth, mass or obstruction: Many other noncancerous growths and abnormalities in the urinary system can cause blood in urine. Imaging studies such as a CT scan and ultrasonography can pick them up. Some may require surgical removal while many can just be observed through careful follow-ups with your doctor.
  • No Detectable Cause:  In many cases, no cause can be found even after a most thorough work-up and no serious urinary disease ever develops. You may be asked to get frequent follow-up tests though for the next three years or more depending on your risk profile.

When to Seek Medical Attention?

Microscopic blood in urine always needs medical attention.  It is definitely not something that you can overlook. Not even if you have no other complaints or abnormal lab findings.

 

Who Treats Microscopic Blood in Urine?

The initial evaluation can be done by your family physician or an internist. Most patients need to be referred to a urologist.

 

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