Occult Blood in Urine: When to Seek Medical Attention

Urinary occult blood issue?

Hello, Doctor.
I have previously consulted your website with questions, and this is my first time reaching out to you.
I have undergone lithotripsy and have had several urine tests.
Sometimes I have trace hematuria (+/-), and sometimes I do not, but I have never had any red blood cells detected.
Yesterday, I needed to undergo a urine test at a laboratory, which showed trace hematuria (1+) and 6-9 red blood cells.
Everything else was normal.
Should I seek medical attention for this? I still have some stones in my kidneys, approximately 0.44 cm.
Thank you.

Er Mao, 50~59 year old female. Ask Date: 2020/12/16

Dr. Li Minghui reply Urology

The occult blood test uses a chemical reaction to identify the presence of hemoglobin in the urine.
Some causes of hematuria can lead to the rupture of red blood cells, making it difficult to see intact red blood cells; in such cases, the occult blood test may be more sensitive than the detection of red blood cells (less likely to miss).
However, a drawback is that other proteins can also cause a positive result, so when the test is positive, it is important to verify whether it is indeed hematuria.
The presence of red blood cells clearly indicates hematuria (microscopic hematuria).
There are many causes of hematuria, including infections, stones, vigorous exercise, and blood or kidney diseases, with malignant tumors being the most concerning.
Since you have kidney stones, the microscopic hematuria may be caused by the stones, so generally, there is no need for excessive worry.
Monitoring the kidney stones with renal and bladder ultrasound should be sufficient.
However, if the hematuria suddenly worsens, such as the appearance of gross hematuria, further investigations may be necessary to rule out malignant tumors or other issues.

Reply Date: 2020/12/16

More Info

When it comes to the presence of occult blood in urine, particularly in a patient with a history of kidney stones, it is essential to approach the situation with caution and awareness of potential underlying issues. Occult blood in urine, or hematuria, can arise from various causes, and understanding when to seek medical attention is crucial for proper diagnosis and management.

In your case, the presence of occult blood (1+) and red blood cells (6-9 per high power field) in your urine test indicates that there is some bleeding occurring in the urinary tract. While the absence of red blood cells in previous tests may suggest that the bleeding is not a constant issue, the current findings warrant further investigation, especially given your history of kidney stones.

When to Seek Medical Attention
1. Persistent Symptoms: If you notice ongoing hematuria or if the blood in your urine persists, it is essential to consult a healthcare provider. Even if the blood is not visible to the naked eye, any indication of blood in the urine should be taken seriously.

2. Associated Symptoms: If you experience additional symptoms such as pain during urination, flank pain, abdominal pain, fever, or changes in urinary frequency, you should seek medical attention promptly. These symptoms may indicate a urinary tract infection, kidney stones, or other serious conditions.

3. History of Kidney Stones: Given your history of kidney stones, it is particularly important to monitor for any changes. Stones can cause irritation and bleeding in the urinary tract, and if they are present, they may need to be addressed to prevent further complications.

4. Follow-Up Testing: Since you have had varying results in previous urine tests, it is advisable to have follow-up testing. A repeat urinalysis, imaging studies (such as an ultrasound or CT scan), or even a cystoscopy may be necessary to determine the source of the bleeding.

Understanding the Implications
The presence of occult blood can be benign, especially in cases of minor trauma or irritation, but it can also indicate more serious conditions such as:
- Urinary Tract Infections (UTIs): These can cause inflammation and bleeding in the bladder or urethra.

- Kidney Stones: As mentioned, stones can lead to bleeding as they move through the urinary tract.

- Glomerular Diseases: Conditions affecting the kidneys' filtering units can lead to hematuria.

- Tumors: Both benign and malignant tumors in the urinary tract can cause blood to appear in the urine.

Recommendations
1. Consult a Urologist: Given your history and current findings, it would be prudent to consult a urologist. They can provide a comprehensive evaluation and determine if further diagnostic tests are necessary.

2. Hydration and Monitoring: Ensure you are well-hydrated, as this can help flush out the urinary system and may alleviate some symptoms. Keep track of any changes in your urinary habits or symptoms.

3. Avoid Self-Diagnosis: While it is helpful to research and understand your symptoms, avoid jumping to conclusions about your condition. Professional medical advice is crucial for accurate diagnosis and treatment.

In summary, while occasional findings of occult blood may not always indicate a serious problem, your specific circumstances—particularly your history of kidney stones—suggest that further evaluation is warranted. Seeking medical attention will help ensure that any potential issues are identified and managed appropriately.

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