Is 0-2 WBC/HPF on Urinalysis Normal?
Yes, 0-2 white blood cells per high-power field (WBC/HPF) on urinalysis is definitively normal and effectively rules out urinary tract infection and significant urinary tract inflammation. 1, 2
Normal Reference Range
The threshold for clinically significant pyuria is ≥3 WBC/HPF according to the American Urological Association's definition of microhematuria workup, which uses this same microscopic examination standard 1
Most clinical guidelines define pyuria requiring further evaluation as ≥5-10 WBC/HPF, making your result of 0-2 WBC/HPF well below any pathological threshold 2, 3
The Infectious Diseases Society of America specifically states that ≥10 WBC/HPF is the standard cutoff for pyuria that warrants consideration of UTI when combined with symptoms 2
Clinical Significance
A finding of 0-2 WBC/HPF has excellent negative predictive value for ruling out urinary tract infection, particularly when combined with negative leukocyte esterase and nitrite testing 2
This WBC count indicates the absence of significant urinary tract inflammation, whether from infection, stones, interstitial cystitis, or other inflammatory conditions 1
In asymptomatic patients with 0-2 WBC/HPF, no further urologic workup is indicated unless there are other concerning findings like hematuria or specific risk factors 1, 2
Important Context
Research shows that even cutoffs of >5 WBC/HPF have only 82% specificity for UTI, meaning your result of 0-2 is definitively in the normal range 4
Studies comparing different thresholds found that >8 WBC/HPF is needed to reliably predict positive urine culture in symptomatic patients, further confirming that 0-2 is normal 5
Automated urinalysis systems may report >2 WBC/HPF as significant pyuria, but this applies to values above 2, not 0-2 5
Clinical Pitfall to Avoid
Do not pursue UTI workup or treatment based solely on symptoms if the urinalysis shows 0-2 WBC/HPF, as the absence of pyuria effectively excludes bacterial cystitis in most clinical scenarios 2
If strong clinical suspicion persists despite normal urinalysis, consider non-infectious causes of urinary symptoms (interstitial cystitis, urethritis, vaginitis) or ensure proper specimen collection technique 2