Haematuria

Haematuria is the presence of red blood cells in the urine. It can either be:

• visible haematuria (VH) - also referred to as macroscopic haematuria or gross haematuria
• non visible haematuria (NVH) - also known as microscopic haematuria or ‘dipstick positive haematuria’ (1)

Significant haematuria is defined as:

• any single episode of VH
• any single episode of symptomatic -NVH (in absence of UTI or other transient causes).
• persistent asymptomatic -NVH (in absence of UTI or other transient causes). Persistence is defined as 2 out of 3 dipsticks positive for NVH(1)

NICE state (3)

• refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer if they are:
  • aged 45 and over and have:
    • unexplained visible haematuria without urinary tract infection or
    • visible haematuria that persists or recurs after successful treatment of urinary tract infection, or
    • aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test
      
      
  • consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection

Note:

• presence of haematuria (VH or NVH) should not be attributed to anti-coagulant or anti-platelet therapy and patients should be evaluated regardless of these medications (1).

Reference:

1. Renal Association and British Association of Urological Surgeons (2008). Joint Consensus Statement on the Initial Assessment of Haematuria
2. Rodgers M et al. Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation; Health Technology Assessment 2006;10(18)
3. NICE. Suspected cancer: recognition and referral. NICE guideline NG12. Published June 2015, last updated October 2023.