Minimal bleeding in urine examination: Is it threat?

Microscopic hematuria
FB Dr Soarawee
Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist
Royal Phnom Penh hospital, Kingdom of Cambodia

Urine examination is a simple one of the most common in the medical investigations, and it always included in the health checkup package program. Urine examination looks and sounds very simply but actually it took advantage than some fewer medical tests than ever before. It is not that “simple” like its sound! By the way this test virtually reflected the current individuals’ health status unprecedented. The essential result from this test can be disclosed; is there any bleeding in your urine or not? This content will drag you to be concentrated on the invisible bleeding in urine or we called it “Microscopic hematuria” in medical term.

Medical check up 2
Urine examination test is a simple investigation which always included in Health check up program.

Microscopic hematuria is defined for at least 7 days presenting 3 red blood cells/HPF in 2 consecutive urine examination tests. Where the bloods coming from? And is it threat? That is the most and routinely questions that patients asked me while they are in my urology clinic.  First of all, I’m going tell you that, it is fine! Don’t be worry! Mostly it won’t cause any serious problem. If that is a problem, you will see your urine very redness with your bare eyes, not invisible like this, but anyway, a positive red blood cell finding in urine examination, we must do a further investigation to ensure that everything is alright.

Medical check up
Microscopic hematuria is a common finding from Medical check up program.

Fewer possible bleeding locations which we should be aware of

  1. Contamination – I must say that most commonly etiology in Microscopic hematuria is the contamination sampling during urine collection method for example
    • Incorrect mid-stream urine collection
    • Test urine examination during the menstrual period (Women patients)
  2. Kidney – Kidney stone, kidney mass, kidney infection or non-surgical related kidney diseases
  3. Ureter – Ureteral stone, ureteral tumor
  4. Bladder – Bladder stone, bladder tumor, bladder infection
  5. Prostate (Men patients) – Prostate disease, prostate cancer, prostate infection
  6. Urethra – Urethral stone, urethral infection
Microscopic CT scan
In case we need the definite investigation on Microscopic hematuria, CT contrasted study is recommended.

The proper methodology in order to make clear in term of etiology of the Microscopic hematuria is the accuracy imaging. CT scan is the definite imaging to answer this kind of problem. When we found the positive clue from CT scan, then we will follow the protocol on each suspicious diagnosis. In the other hand, if we found nothing, we can ensure the patient that the symptom is fine, and it required to have the annual simple urine examination is all. The recommendation from American Urology Association guideline in 2020, suggest that we can let go the patient free from the annual following up program if the urine examination turn to negative finding. See you guys on the next content!

Any questions, you can feel free to discuss with me.

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