Haematuria 🩸
Clinical guide for assessing and managing haematuria (blood in urine). Causes, investigations, urology referral, and emergency management for on-call doctors.
🧠 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
🕒 26 / 05 / 2026 — 12:30 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: _______