Blood in Urine with Pain or No Pain Explained

How to read urine test results which contain blood in urine, and how to understand the clinical importance of red blood cells in urine analysis, learn how to match the possible cause with your signs and symptoms before going to a doctor. this article is about what does blood in urine means for different human ages and genders.
Is there certainly blood in your urine?
Before continue reading, it is worth considering whether you have eaten beets recently, where the urine can be colored in pink and causing concern which is superfluous. Some medications can also convert urine color to brown or red, such as antibiotics, and nitrofurantoin.
Also, make sure that the blood is coming from the organ actually the source of the urine and not the vagina (if you are a woman) or another location around it.
What does it mean when blood cells appear in urine analysis test?
The presence of RBCs in the urine is associated with a degree of damage to membranes of interior organ or damage of some blood cells itself.
Where Blood in Urine Might Come From?
Blood cells in urine may come from kidney component or vascular injury within the genitourinary tract (include in males the Bladder, Prostate, Urethra, Penis, and Testis and in females the kidneys, ureters, bladder, urethra, and uterus, ovaries, fallopian tubes and vagina.).
What hematuria is?
Hematuria is a medical term describe the presence of red blood cells and or visible blood clots in the urine of a person.
Hematuria is most closely related to disorders of renal or genitourinary origin in which bleeding is the result of trauma or damage to the organs of these systems. Major causes of hematuria include renal calculi, glomerular diseases, tumors, trauma, pyelonephritis, exposure to toxic chemicals, and anticoagulant therapy.
What is normal limits for red blood cells in urine test for healthy person?
Commonly listed values include zero, two or three RBCs per hpf,
Any amount of blood greater than five cells per microliter of urine is considered clinically significant.
What’s found in a urine test?
RBCs are routinely reported as the average number seen in 10 high power fields (HPFs). Also some laboratories report the morphological shape of red blood cells in the urine upon the request of your doctor.
Why blood in urine, why hematuria?
1-Hematuria due to renal diseases:
Our kidney’s the responsible human organ for filtering blood from wastes into a filtrate called “urine”, and each kidney filtration system has the ability to preserve cells and essential blood components from being lost while filtering.
Blood cells of normal kidney must not leak into urine, if red blood cells found in urine it may be a result of abnormal filtration process (kidney illness) or some causes related to the kidney system.
2-RBCs in urine due to trauma or infections as a result of severity.
Read the complete list of causes of blood in urine?
hematuria common causes
When blood found in urine test is not important or not clinically significant?
Hematuria of nonpathologic significance is observed following strenuous exercise and during menstruation.
It means you should not worry if your urine appears reddish after doing exercises or just after walking a long distance, and you must not worry when your urine test come up with few blood cells after doing training or running for a while.
The possibility of menstrual contamination must also be considered in specimens from female patients which not related to a disease unless the women experience an abnormal menses time.
Is it necessary to take a urine test if my urine appear reddish?
A person observes any abnormal alteration of urine color, odor, appearance or volume must take a urine test.
However, the presence or absence of RBCs in the sediment cannot always be correlated with specimen color or a positive “chemical test” result for blood.
The presence of hemoglobin that has been filtered by the glomerulus produces and appears as a red urine with a positive chemical test result for blood in the absence of microscopic hematuria. Likewise, a specimen appearing macroscopically normal may contain a small but pathologically significant number of RBCs when examined microscopically.
Also some drugs, bacteria, urine salts alter the visible properties of the urine fluid.
When to receive a urine test results?
Most laboratories take less than half an hour to finish your urine analysis.
Is the number and quantity of red cells in urine significant?
The quantity of cells present (few, moderate, marked, over count) is indicative of the extent of the damage or injury
But doctor usually not rely much on the exact numbers (10,12, 15) on follow up.
The meaning of: Over count blood in urine or over 100 red cells in urine per HPF, Visible blood clots.
When macroscopic hematuria is present, the urine appears cloudy with a red to brown color. Microscopic analysis
may be reported in terms of greater than 100 per hpf or as specified by laboratory protocol. Macroscopic hematuria is frequently associated with advanced glomerular damage but is also seen with damage to the vascular integrity of the urinary tract caused by trauma, acute infection or inflammation, and coagulation disorders.
Microscopic hematuria of red blood cells in urine less than 100 cells per high power field:
Few blood cells in urine or plus one (+) in some reports:
can be an early diagnostic marker of glomerular disorders and malignancy of the urinary tract and to confirm the presence of renal calculi. Also can be a mild response against hits and trauma of external organs
Many RBCs or moderate amount means that there are currently damage in one of the urinary tract and genital areas
If Hayline casts present in urine with blood cells:
The presence of not only RBCs but also hyaline, granular, and RBC casts may be seen following strenuous exercise. These abnormalities are nonpathologic and disappear after rest unless the urine report mention the observation of pus cells and or proteinuria. take a blood test for kidney function.
Reasons for blood in urine if pain or no pain found:
Causes of Blood in urine with Pain in lower back
1-Stones if plugged the urine pathway,
2-UTI of the upper urinary tract (e.g. kidney)
3-STD when causing UTI.
4- Renal diseases
6-Amenorrhea in women
7-Restricted urine or semen in men
8-Injury to urethra in women and men.
Causes of Blood in urine with no pain or a little pain.
1-stones may drop a little amount of blood in urine if they aggregates well or they are tiny and pass into urine safely.
2-UTI of the lower urinary tract may cause no pain or mild pain.
3-Physiological causes as exercises, pigmentation foods, or medications.
Are there Accurate laboratory techniques to detect blood in urine?
Visible examination of a urine sample can detect blood macro-clots, large quantities of RBCs, urine reddish color, but visible macroscopic examination unable to provide the cause by only the naked eye.
Microscopic examination of the urinary sediment shows intact red blood cells only, and the morphology of RBCs.
Urine streps discover the presence of both RBCs and Free hemoglobin resulted from lysis of RBCs (hemolysis).
chemical tests for hemoglobin provide the most accurate means for determining the presence of blood. Once
blood has been detected, the microscopic examination can be used to differentiate between hematuria and hemoglobinuria.
Some causes of false urine test results include:
False-positive reactions owing to
Reaction Interference of urine components with chemicals in the urine stex:

  • Menstrual contamination
  • If strong oxidizing detergents are present in the specimen container.
  • Vegetable peroxidase
  • Bacterial enzymes, including an Escherichia coli peroxidase, may also cause false-positive reactions. Therefore, sediments containing bacteria should be checked closely for the presence of red blood cells.

Causes of false-negative reagent strip reactions for blood:
Traditionally, ascorbic acid has been associated with false negative blood results in urine, both Multistix and Chemstrip have modified their reagent strips to reduce this interference to very high levels (25 mg/dL) of ascorbic
acid. Multistix uses a peroxide that is less subject to reduction by ascorbic acid, and Chemstrip overlays the reagent pad with an iodate-impregnated mesh that oxidizes the ascorbic acid prior to its reaching the reaction pad.
Also False-negative reactions can be resulted from:

  • When urine with a high specific gravity contains crenated red blood cells that do not lyse when they come in contact with the reagent pad.
  • Decreased reactivity may also be seen when formalin is used as a preservative.
  • When the hypertension medication, captopril,
  • High concentrations of nitrite (greater than 10 mg/dL) are present.
  • If red blood cells settle to the bottom of the specimen container, and failure to mix the specimen prior to testing causes a falsely decreased reading, the experienced technologist can avoid this issue by well mixing and centrifuging the urine sample prior to examination.

 Do I need to see a specialist?
When you must seen a doctor if blood in urine found?, if applicable any of the following cases:

  • Have visible blood in the urine without pain, and tests showed the absence of inflammation
  • Have blood in urine with no specific cause: E.g. microscopic blood in urine without pain, and microscopic blood in urine without protein in urine
  • ِِAge 40 or more and continue exposure to urinary tract infections and presence of blood in the urine
  • Age 50 or more and a urine test reveals continuous blood in urine with no clear reason.
  • You have a swelling or lump in the abdomen (a possible tumor), which must be examined through a physical examination by a physician or by scanning.
  • The detection of both blood and albumin in urine, this will be verified by the kidney doctor (kidney specialist) instead of the urologist.
  • Kidney stones or Alport syndrome are suggested causes of hematuria in young men.
  • You have a Family history of kidney diseases or stones.
  • You’re on medications such as pain relievers NSAIDS, antibiotics, laxative Ex-lax, and blood thinners.
  • Have Risk Factors for Cervical Dysplasia or related to the risk of HPV

Define before Decide:
Causes are a little different for Infants, Child, young boy or girl, over 40 men or women.
Adult Female: irregular period, missed period, healthy women, menopause,
Pregnant female: first trimester, last trimester, abortion signs
Blood in urine is found with Red color or yellow color, Small urine volume, Albumin or proteinuria, Pus, Turbid, or with Hemoglobin in urine.
Read more in complete list of reasons:
Blood in urine in men
Blood in urine in women.
Children blood in urine
Elders blood in urine.
Have a query, just lemme know.

Dr.Megan Ralf

A Medical laboratory Scientist who devoted his life to medical and laboratory sciences, writes his everyday expertise dealing with various pathological conditions through laboratory diagnosis of different body fluids, also participating in many workshops for first aids, infection control, and urgent care. Also Dr Megan Ralf coaching many medical teams.

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