Haematuria 🩸

Clinical guide for assessing and managing haematuria (blood in urine). Causes, investigations, urology referral, and emergency management for on-call doctors.

Add to Tasks

🧠 Definition

  • Haematuria refers to the presence of red blood cells in urine.
  • It may be microscopic (only on dipstick or microscopy) or macroscopic (visible to patient/clinician).

📞 What to Ask / Orders to Make

  • Visible vs. non-visible haematuria?
  • Any anticoagulation/antiplatelet medications?
  • History of trauma, instrumentation, recent vigorous exercise?
  • Request urine dipstick, send for MCS and cytology.
  • Order FBC, U&E, coagulation profile.
  • Arrange imaging (CT KUB for suspected stone, renal USS for painless haematuria).
  • Consult urology early if visible haematuria with clot retention or haemodynamic instability.

🧾 History

  • Onset and duration of haematuria.
  • Painful or painless? Associated LUTS?
  • Trauma, infection, menstruation, recent catheter?
  • Smoking history (urothelial cancer risk).
  • Anticoagulant use (e.g. warfarin, DOACs)?

🩺 Examination

  • Check vitals (esp. signs of hypovolaemia if visible haematuria).
  • Abdominal exam: renal angle tenderness, suprapubic distension.
  • Inspect external genitalia, consider DRE if male >50.

🔍 Investigations

  • Urine dipstick, microscopy, culture and cytology.
  • FBC, U&Es, coagulation screen.
  • Renal tract imaging: USS vs. CT KUB vs. CT urogram depending on clinical context.
  • Flexible cystoscopy in all cases of visible haematuria (esp. if over 45).

💊 Management

  • Resuscitate if haemodynamically unstable: IV fluids, blood products as needed.
  • Discuss any anticoagulation with senior.
  • For significant haematuria with clot retention, 3-way catheter and bladder irrigation.
  • Treat underlying cause: e.g. UTI, stone, trauma, malignancy.
  • Refer to urology for further investigation and follow-up.

🚩 Red Flags

  • Painless visible haematuria (suspect malignancy).
  • Persistent microscopic haematuria + proteinuria or raised creatinine (consider glomerulonephritis).
  • Clot retention with distended bladder → emergency urological input.

Note Template

Ready-to-use clinical note structure

🕒 11 / 04 / 2026 — 11:28

ATRP re: haematuria
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [UTI, stones, malignancy, anticoagulation]

🧾 Hx:
• Onset and duration
• Visible or microscopic haematuria
• Associated symptoms: dysuria, frequency, pain
• Trauma, recent procedures, anticoagulants

🩺 Exam:
• Vitals: HR __ BP __ Temp __ RR __ SpO₂ __
• Abdomen and flank tenderness
• Genital and perineal exam if indicated

📋 Impression:
Likely cause: [infection / stones / malignancy / trauma]

📌 Plan:
• Urinalysis and microscopy
• Bloods: U&E, coagulation profile
• Imaging: ultrasound or CT KUB as indicated
• Stop anticoagulants if safe and relevant
• Refer urology if persistent or concerning

👤 [Your Name], [Role]
IMC: _______
Add to Tasks
Haematuria 🩸 - BetterCall.ie