HAEMATURIA

1. HAEMATURIA Dipstick positive means one + blood or more on the dipstick. A trace is not significant What to do about a patient with frequency and dysuria who is dipstick positive for blood Check if they have a UTI (nitrites and leucocytes on dipstick or MSU confirmation) If it’s a UTI, treat and repeat the dipstick. If the blood has disappeared and the symptoms too, they no longer have haematuria and are safe. No action needed. What to do about patients who are dipstick positive but no symptoms If they are >40yrs old repeat it 2 more times. If 2 positives in 3 tests - REFER If they are <40yrs old the chance of malignancy is remote. So do the following tests MSU FBC U&E, creatinine, ACR and glucose Renal ultrasound. If all these are normal they are safe AND DO NOT NEED FURTHER INVESTIGATION

2. HAEMATURIA PATIENTS TO REFER AS 2 WEEK WAITERS All frank (visible) haematuria All symptomatic patients with dipstick haematuria who do not have a proven UTI or the blood and symptoms remain after treatment. All asymptomatic dipstick haematuria over 40 who have 2 out of 3 positive dipsticks The reason for these rules is that With frank haematuria the chance of a malignancy is 25% With asymptomatic haematuria the chance of malignancy is 2.5% but is remote under 40 with normal tests above. What about microscopy It is not as accurate as dipstick so DO NOT USE IT TO CONFIRM DIPSTICK HAEMATURIA, just repeat the dipstick What about patients who’ve had negative investigation for microscopic haematuria but it persists. There is no need to re-investigate. One investigation per lifetime is safe.