macroscopic haematuria

Last reviewed 09/2021

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 haemtauria
  • 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
        • note in the previous version of the guidance (4) NICE stated to " patients aged 50 years and older who are found to have unexplained microscopic haematuria, an urgent referral should be made"

    • consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection


  • 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).