From the Guidelines
The presence of blood and leukocytes in a urinalysis (UA) strongly suggests a urinary tract infection (UTI) or other underlying conditions, and further evaluation is necessary to determine the cause and appropriate treatment. According to the American College of Physicians, hematuria, which is the presence of blood in the urine, can be a sign of occult cancer or other serious underlying conditions 1. The presence of leukocytes indicates inflammation, which can be caused by a UTI or other conditions.
Evaluation and Treatment
- The initial evaluation should include a thorough history and physical examination, urinalysis, and serologic testing 1.
- The definition of microscopic hematuria is three or more red blood cells per high-power field on microscopic evaluation of urinary sediment from two of three properly collected urinalysis specimens 1.
- Empiric antibiotic treatment should be initiated while awaiting urine culture results, with first-line therapy including nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin 1.
- For complicated UTIs or pyelonephritis, consider ciprofloxacin or ceftriaxone.
- Patients should increase fluid intake and complete the full antibiotic course even if symptoms resolve quickly.
Further Evaluation
- If symptoms persist after treatment, recurrent infections occur, or if the patient has risk factors like immunosuppression, diabetes, or anatomical abnormalities, further evaluation with imaging or specialist referral may be necessary 1.
- The American Urological Association recommends that patients with asymptomatic microhematuria undergo a thorough evaluation, including urinalysis, serologic testing, and imaging studies as needed 1.
- The ACR Appropriateness Criteria for hematuria recommend that all patients with hematuria undergo a thorough history and physical examination, urinalysis, and serologic testing prior to any initial imaging 1.
Key Considerations
- The presence of hematuria, even if microscopic, warrants further evaluation to determine the cause and appropriate treatment.
- The presence of leukocytes indicates inflammation, which can be caused by a UTI or other conditions.
- Patients with risk factors for underlying conditions, such as immunosuppression, diabetes, or anatomical abnormalities, should undergo further evaluation and monitoring.
From the Research
Interpretation of Urinalysis (UA) with Blood and Leukocytes
- The presence of blood and leukocytes in a urinalysis can indicate various conditions, including urinary tract infections (UTIs) and other pathologies 2.
- Leukocyturia, or the presence of leukocytes in the urine, is often associated with bacteriuria, or the presence of bacteria in the urine, and can be a sign of a UTI 3.
- The type of leukocytes present in the urine can also provide information about the underlying condition, with neutrophil or eosinophil granulocytes or lymphocytes indicating different types of infections or inflammatory responses 3.
Diagnostic Evaluation
- When leukocyturia is present in the absence of significant bacteriuria, further diagnostic evaluation is necessary to determine the underlying cause 3.
- Urine flow cytometry can be used to measure leukocyte and bacterial counts in the urine, and can help predict significant bacterial growth in urine culture and diagnose UTIs 4.
- The interpretation of urinalysis results should take into account the clinical presentation of the patient, including symptoms such as fever, dysuria, and urinary frequency 4.
Clinical Correlations
- The presence of blood in the urine, or hematuria, can be a sign of various conditions, including UTIs, kidney stones, and cancer 5.
- The evaluation of hematuria should include a thorough medical history, physical examination, and urinalysis, as well as imaging studies and other diagnostic tests as needed 5.
- Reflexive urinalysis and urine culture testing can be used to help diagnose UTIs and other conditions, but evidence-based guidelines for optimal reflexive criteria and workflows are lacking 6.