- Blood (Urine)
- Dipstick blood (Urine)
- Urine blood (Dipstick)
- 10-20 mL urine in a disposable sterile plastic container or plain tube
- Midstream random urine sample to be collected
Additional information
- Use a freshly voided specimen
- Send specimen to lab immediately
- If delay of >1hr is expected, refrigerate the specimen
- Attention should be given to avoid having skin epithelium, secretions, hair, lint, etc from contaminating the sample
- Avoid preservatives or any other contamination
- Instructions for clean catch midstream urine collection:
- For male
- Wash hands thoroughly
- Cleanse the meatus
- Void a small amount into the toilet
- Then, void directly into the specimen container
- For female
- Wash hands thoroughly
- Cleanse the labia from front to back
- While keeping the labia separated, void a small amount into the toilet
- Without interrupting the urine stream, void directly into the specimen container
- Urine dipsticks for blood detects the presence of red blood cells (hematuria), free hemoglobin (hemoglobinuria) and free myoglobin (myoglobuniria) in the urine, which can be gross or microscopic
- A normal healthy person on an average excretes about 1 million red blood cells (RBC) in the urine each day, which is not visible and is not considered hematuria.
- The dipstick method allows detection of intact RBCs when the number is >10 cells/µL of urine
- This test is based on peroxidase activity of erythrocytes and detects intact as well as lysed RBCs. This test is more sensitive to hemoglobin and myoglobin than to intact red blood cells.
- Dipstick testing for hematuria is a screening tool which, if positive, needs the support of microscopy to make a definitive diagnosis
- The clinical utility of the urine dipstick for blood includes:
- As a screening test, an urinalysis is performed as a part of
- Routine physical examination
- Pregnancy workup
- On admission to a healthcare facility
- Before surgery
- Evaluation of kidney function
- Evaluation of hematuria or hemoglobinuria caused by following conditions from anywhere along the urinary tract
- Trauma
- Infection
- Inflammation
- Infarction
- Calculi
- Neoplasia
- Medications
- Evaluation of blood clotting disorders
- Detection of certain chronic conditions such as diabetes, hypertension and sickle cell anemia
- According to the American Urological Association, the presence of three or more red blood cells (RBCs) per high-powered field (HPF) in two of three urine samples is defined as hematuria
- Color changes on the dip reagent sticks can be correlated with the different levels of hemoglobin in the urine (gradients of negative, moderate, and high). The degree of hematuria can be estimated by the intensity of the speckled pattern.
- Hemoglobinuria is suspected when no RBCs are seen or the number seen does not correspond to the degree of color on the dipstick.
- Myoglobinemia may be suspected if the urine is cherry-red, no RBCs are seen, and serum enzymes (CK) for muscle destruction are elevated.
- Related laboratory tests include:
- Bladder cancer markers
- Blood and urine creatinine
- Blood and
- Blood and urine urea nitrogen
- Blood and
- Complete blood count
- Kidney stone analysis
- Microalbumin
- Urine culture
- Urine calcium
- Urine osmolality
- Urine oxalate
- Urine phosphorus
Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.
- Dipstick for blood: negative/none
Conditions associated with hematuria include:
- Glomerular causes
- Fabry's disease
- Familial causes
- Focal segmental glomerulonephritis
- Glomerular C3 deposition
- Goodpasture's disease
- Hemolytic-uremic syndrome
- Henoch-Schönlein purpura
- Hereditary nephritis (Alport's syndrome)
- IgA nephropathy (Berger's disease)
- Mesangioproliferative glomerulonephritis
- Nail-patella syndrome
- Postinfectious glomerulonephritis
- Primary glomerulonephritis
- Rapidly progressive glomerulonephritis
- Secondary glomerulonephritis
- Systemic lupus nephritis
- Thin basement-membrane disease
- Thrombotic thrombocytopenic purpura
- Vasculitis
- Renal/Urologic causes
- Alport's syndrome
- Analgesic nephropathy
- Arteriovenous malformation
- Benign hematuria
- Benign prostatic hyperplasia (BPH)
- Bladder diverticulum
- Cancer of GU tract
- Catheter or other instrumentation of GU tract
- Cystitis
- Drugs (listed below)
- Hypercalciuria
- Hyperuricosuria
- IgA nephropathy (Berger's disease)
- Interstitial nephritis
- Loin pain-hematuria syndrome
- Malignant hypertension
- Meatal ulcers
- Medullary sponge kidney
- Nephrolithiasis (Kidney stones)
- Obstructive uropathy
- Papillary necrosis
- Polycystic kidney disease
- Prostatitis
- Pyelonephritis
- Radiation to GU tract
- Renal artery embolism
- Renal vein thrombosis
- Schistosoma haematobium infection
- Telangiectasias
- Trauma/surgery/biopsy
- Tuberculosis
- Tubulointerstitial diseases
- Tumors
- Urethritis
- Ureterocele
- Vascular causes (Other)
- Hemolytic anemias
- Fava bean sensitivity
- Glucose-6-phosphate dehydrogenase deficiency
- Paroxysmal hemoglobinuria
- Sickle cell anemia
- Thalassemia
- Systemic causes
- Disseminated intravascular coagulation
- Endocarditis
- Malaria
- Malignant hypertension
- Scurvy
- Tuberculosis
- Vasculitis
- Other conditions
- Anticoagulants (aspirin, heparin, warfarin)
- Bleeding disorders such as hemophilia
- Certain chemical agents and alkaloids such as poisonous mushrooms or snake venom
- Dehydration
- Endometriosis
- Extensive burns
- Febrile illnesses
- Heavy smokers
- Leukemia
- Sexual intercourse
- Strenuous exercise ("march hemoglobinuria")
- Thrombocytopenia
- Transfusion reactions
- Viral infection
Various mechanisms by which certain drugs may cause a positive result for blood or Hgb in the urine include:
- Drugs toxic to the kidneys (e.g., bacitracin, amphotericin)
- Drugs that alter blood clotting (warfarin)
- Drugs that cause hemolysis of RBCs (aspirin)
- Drugs that may give a false-positive result (eg, bromides, copper, iodides, oxidizing agents)
Drug induced:
- Abciximab
- Acetozolamide
- Aldesleukin
- Allopurinol
- Alprostadil
- Alteplase
- Aminoglycosides
- Amitriptyline
- Amphotericin
- Anticoagulants
- Anticonvulsants
- Ardeparin
- Aspirin
- Auranofin
- Aurothioglucose
- Bacitracin
- Basiliximab
- Bcg BCG vaccine
- Bicalutamide
- Busulfan
- Candesartan
- Carvedilol
- Cephalosporins
- Chemotherapy
- Chlorothiazide
- Chlorpromazine
- Cidofovir
- Cimetidine
- Ciprofloxacin
- Clofibrate
- Clopidogrel
- Clozapine
- Colchicine
- Cyclophosphamide
- Danazol
- Diethylstilbestrol
- Diphenhydramine
- Donepezil
- Doxorubicin
- Ethosuximide
- Etretinate
- Fenoprofen
- Furosemide
- Gabapentin
- Ganciclovir
- Gemcitabine
- Gold
- Goserelin
- Heparin
- Heroin
- Ibuprofen
- Ifosfamide
- Indinavir
- Indomethacin
- Isoniazide
- Isotretinoin
- Itraconazole
- Ketoprofen
- Ketorolac
- Lansoprazole
- Leuprolide
- Lithium
- Lomefloxacin
- Mefenamic acid
- Mercury compounds
- Mesalamine
- Methotrexate
- Metyrosine
- Mirtazapine
- Misoprostol
- Mycophenolate
- Naproxen
- Nisoldipine
- NSAIDs
- Octreotide
- Ofloxacin
- Olsalazine
- Omeprazole
- Oral contraceptives
- Oxaprozin
- Oxycodone
- Paroxetine
- Pegaspargase
- Penicillamine
- Penicillin
- Phenolphthalein
- Phenytoin
- Piroxicam
- Probenecid
- Proleukin
- Pyrimethamine
- Quinine
- Ranitidine
- Rifampin
- Risperidone
- Sargramostim
- Sertraline
- Somatotropin
- Sulfasalazine
- Sulfisoxazole
- Sulindac
- Tacrolimus
- Thiabendazole
- Ticlopidine
- Tolazoline
- Tolcapone
- Tolmetin
- Trastuzumab
- Triamterene
- Urokinase
- Venlafaxine
- Vincristine
- Vitamin D
- Warfarin
Factors causing false positive occult blood in urine or pseudohematuria include:
- Myoglobinuria
- Menstruation
- Foods (beets, blackberries, and rhubarb)
- Food coloring
- Certain medications like
- Ibuprofen
- Laxatives
- Levodopa
- Nitrofurantoin
- Pain medications
- Phenytoin
- Quinine
- Rifampin
- Oxidizing contaminants such as
- Bleach
- Copper
- Hypochlorite
- Iodine
- Microbial peroxidase (urinary tract infection)
- Argyropoulos A et al. The presence of microscopic hematuria detected by urine dipstick test in the evaluation of patients with renal colic. Urol Res. 2004 Aug;32(4):294-7. Epub 2004 Mar 26.
- Bergstein J et al. The clinical significance of asymptomatic gross and microscopic hematuria in children. Arch Pediatr Adolesc Med. 2005 Apr;159(4):353-5.
- Dreisler E et al. [Use of dipsticks and microscope in the diagnosis of hematuria in general practice] [Article in Danish]. Ugeskr Laeger. 2002 Jul 1;164(27):3537-41.
- eMedicine from WebMD®. Hematuria. [Homepage on the Internet] ©1996-2006. Last updated on August 17, 2006. Last accessed on November 30, 2006. Available at URL: http://www.emedicine.com/ped/topic951.htm
- Hedelin H et al. Screening for bladder tumours in men aged 60-70 years with a bladder tumour marker (UBC) and dipstick-detected haematuria using both white-light and fluorescence cystoscopy. Scand J Urol Nephrol. 2006;40(1):26-30.
- LabTestsOnline®. Urinalysis. [Homepage on the Internet] ©2001-2006. Last reviewed on May 9, 2005. Last accessed on November 22, 2006. Available at URL: http://www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams-2.html
- Simerville JA et al. Urinalysis: A Comprehensive Review. Am Fam Physician. 2005 Mar 15;71(6):1153-62.
- UTMB Laboratory Survival Guide®. URINALYSIS (Chemistry and Microscopic). [Homepage on the Internet]© 2006. Last reviewed in February 2006. Last accessed on November 22, 2006. Available at URL: http://www.utmb.edu/lsg/LabSurvivalGuide/chem/URINALYSIS.html