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 "..in 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

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 (June 2015). Referral guidelines for suspected cancer.
• (4) NICE (June 2005). Referral guidelines for suspected cancer.