Haematuria is the presence of red cells in urine. It is abnormal and always requires further investigation. It may be macroscopic (visible to the naked eye) or microscopic (when 3-5 red blood cells per high power field are seen). Both are commonly encountered in the emergency department [1].
Health screening programmes have found haematuria to be present in 2-4% of men and 8-11% of women [4]. Microscopic haematuria is most often an incidental finding, but may be associated with malignancy in up to 10% of cases [2]. Somewhat worryingly, studies have shown that 39% of patients with microscopic haematuria on screening analysis do not receive correct follow up testing [14]. Malignancy has been reported in up to 34% of cases of macroscopic haematuria [2].
Learning bite
Haematuria is considered urinary tract malignancy until proven otherwise. All patients with haematuria need rapid follow up and should be referred to 2 week wait urology clinics. Gross hematuria more often indicates a lower tract cause, whereas microscopic hematuria tends to occur with kidney disease.