The term hematuria indicates the presence of blood in the urine. It can be a visually appreciable phenomenon ( macroscopic hematuria ) or a sneaky event, ascertainable only through the microscopic search for red blood cells in the urinary sediment. In this article, we will give you a complete guide about blood clots in urine.
Table of Contents
Blood is a substance typically foreign to the composition of the urine. For this reason, the finding of this clinical sign causes some concern.
The presence of red blood cells in the blood clots in urine (the medical term is “hematuria”) can originate from anywhere in the urinary tract :
- Ureters (which connect the kidneys to the bladder)
- Bladder ;
Certain diseases that affect other parts of the body can also cause blood in the urine. Also, some triggers may differ depending on sex.
Hematuria can manifest itself in various ways:
- It can present itself as an isolated or recurrent episode.
- Urine may appear blood-colored (frank hematuria) or have a pinkish tint or cloudy. Appearance. This feature can vary based on the severity of the bleeding and the timing with which it occurred.
- Frank hematuria (red): indicates considerable bleeding in progress.
- “Flesh-washed” hematuria indicates slight bleeding.
- Sometimes, the body expels small blood clots, making minor changes to the rest of the urine’s color.
- Again, blood can only appear at the beginning of urination or in its final phase; initial hematuria (i.e., present in the initial phase of urination ) suggests a prostatic or urethral origin of the bleeding.
Many of the causes of hematuria are of absolutely benign origin (such as a urinary tract infection); others may presage a major disorder affecting vital organs (e.g., kidney disease or cancer ). For these reasons, you need to see your doctor or urologist as soon as possible.
We speak of macrohematuria when the amount of blood in the urine is such as to be visible to the naked eye or to change its color.
Microhematuria: Blood Clots In Urine
Microhematuria occurs when the amount of blood eliminated is modest and is not visible to the naked eye.
Appearance of urine
In gross hematuria, the urine color varies according to the amount of blood loss; a hemorrhage of 1 ml is enough to make the phenomenon visually appreciable. The macroscopic presence of blood in the urine generally causes the liquid to take on different red shades. In some cases, however, the blood traces can give the urine a different color. For example, when the urinary pH is unusually acidic, the renal excretion product takes on shades closer to dark brown.
Even when the urine is stationed for a long time in the urinary tract, the oxidation of hemoglobin present in blood traces makes it darker. Conversely, in an acute lesion, followed by rapid urinary elimination, the excrement takes on a deep red color.
Reddish urine is not necessarily synonymous with hematuria
The urine, produced by the kidney’s filtration activity and periodically eliminated with the act of urination, can take on a reddish color even in the absence of hematuria. This phenomenon may be due, for example, to some drugs (cascara-based laxatives, phenacetin, phenytoin, ibuprofen, methyldopa, rifampicin ) or the conspicuous intake of certain foods ( beets and rhubarb ). Finally, during the
menstrual flow, the apparent presence of blood in the urine may be due to contamination with vaginal bleeding or endometriosis of the urinary tract. For all these reasons, in the face of suspicion of hematuria, it is essential to perform a urine test promptly to obtain confirmation of the actual presence of blood inside them.
Because it is measured: Blood Clots In Urine
Blood in the urine can be demonstrated by placing a drop of the urine under a microscope. However, it is often possible to notice this symptom even with the naked eye.
In the presence of hematuria, a visit to the general practitioner or urologist allows you to frame the problem by evaluating:
- Characteristics of hematuria: extent, coloration, permanence during all or part of urination;
- The possible presence of associated problems such as trauma, pain, urination disorders, fever, pharyngeal infections, etc.
After collecting the relevant clinical features of the hematuria from the patient and evaluating the patient by physical examination, the physician will request appropriate investigations to ascertain the cause.
The tests to be performed vary from case to case but are generally performed:
- Urinalysis with urine culture, antibiogram, and sediment assessment to assess for any signs of kidney disease or urinary tract infections;
- Ultrasound of the urinary tract to determine the extent of damage from trauma, the presence of stones, or the urinary tract’s malformations.
Typically, no blood is found in the urine, and erythrocytes are absent (or <3 GR) on examining the urinary sediment.
Causes: Blood Clots In Urine
The urological causes of hematuria include:
- Cystitis (inflammation of the bladder wall)
- Urinary tract infections.
- Benign prostatic hyperplasia, especially in men over 40.
- Prostate cancer.
- Kidney, ureteral, or bladder stones.
- So kidney disease (such as pyelonephritis, glomerulonephritis, and chronic nephritis).
- Kidney or urinary tract trauma (such as a blow to the lower chest or a stab wound)
- Rupture of cysts (more frequent in the case of the polycystic kidney).
- Tumors of the bladder, ureter, or kidney.
- Wilms tumor (in children)
Other causes of blood in the urine include:
- Medications ( anti-inflammatory NSAIDs , acetylsalicylic acid , warfarin or clopidogrel )
- Prolonged and repeated physical exercise (in particular, the marathon ).
- Acquired or congenital dysfunctions of platelet aggregation or coagulation.
- Severe burns.
False hematuria (pseudohematuria)
Alongside all these causes, there are also false positives that can make the urine a reddish pigmentation, not easily distinguishable from hematuria. In women of childbearing age, for example, menstrual losses can sometimes be mistaken for hematuria. In these cases, the unusual staining of the urine disappears with the end of menstruation. Excessive intake of certain foods (particularly: beets, blueberries, rhubarb, and food dyes ) or certain medications (such as rifampicin) can also stain urine red or darker in color.
The urine turns red even in the case of myoglobinuria (elimination of myoglobin caused by muscle damage) or hemoglobinuria (caused by intense hemolysis such as in favism crises ). Hematuria can also occur in the presence of traces of porphyrins (intermediates in the biosynthesis of hemoglobin) and urates, but also endometriosis can alter the colour of the urine. A thorough urinalysis can unmask cases of false hematuria with sediment assessment.
Symptoms associated with hematuria: what are they?
The presence of blood can be totally asymptomatic (haematuria “out of the blue”) or associated with other irritative disorders, such as difficult urination and urine production that is decidedly different from the straw yellow color normality.
Symptoms such as urinary urgency (urge to urinate), pollakiuria, fever, chills, and burning are typical of a urinary infection, which should be diagnosed with an appropriate culture. Pain localized to one side of the abdomen, which radiates to the back, groin, and genital area, maybe due to the presence of kidney or urethral stones.
How it is measured
To evaluate the causes of hematuria, it is necessary to collect a small amount of urine in the morning, fasting.
Preparation: Blood Clots In Urine
Urine should be collected in a sterile disposable container. This should be closed carefully immediately afterward and should be taken to the laboratory within two hours. However, some tests must collect all the urine released over a whole day (24 hours). In this case, large containers (2 to 3 liters) must be used.
The urine, produced by the kidney, is conveyed into the bladder through small tubes called ureters; from here, through the urethra, it comes out with the act of urination. For this reason, until a few years ago, hematuria’s diagnosis was based on the three-glass test. If gross hematuria becomes evident in the third cup, or if the colour becomes more and more intense as the flow continues, it is probably bladder hemorrhage, mild in the first case and more severe in the second final, if there are traces of blood in all three glasses, it is generally a hemorrhage upstream of the urinary tract, i.e., at the level of the kidneys or ureters.
Today, the examination of the three glasses has fallen into disuse due to the advent of more modern and effective technologies in identifying the origin of the problem. We must not forget that hematuria is not a diagnosis but a symptom of potentially serious pathology. Consequently, a timely and accurate diagnosis is essential before choosing the right therapy.
The most used techniques are:
- Renal, bladder, and prostate ultrasound.
- Abdominal-pelvic CT scan.
The most frequently associated pathologies associated with the finding of blood in the blood clots in urine are the presence of stones, neoplasms, or inflammation in the kidney, bladder, or urinary tract. The hematuria may also be related to tuberculosis, cystitis, anticoagulant drugs, polycystic kidney disease, prostatitis, adenomas to the prostate, or interesting trauma to the kidney and/or urinary tract.
Fundamental for an initial diagnosis, pending the appropriate investigations, is the assessment of the associated symptoms. For example, if the loss of blood in the urine is concomitant with back pain type colic or gravitational, probably due to the presence of renal or ureteral stones.
Interpretation of Results: Blood Clots In Urine
When blood is detected in the urine, the degree of alarm varies considerably: it can be mild and easy to treat or severe and potentially fatal. The finding of blood in the blood clots in urine is a symptom that should never be ignored. If recurring, its importance increases. Regardless of whether the hematuria is copious or present in minimal traces, the doctor will always evaluate the situation and establish the best therapeutic approach to the problem.
Treatments depend on the type of disease that caused the disorder.
- If the blood loss in the urine is linked to an infection, therapy is based on antibiotics administration. A conscientious doctor will recommend the use of narrow-spectrum drugs, after evaluating the results of the anti program, an instrumental test to identify the most suitable medication to combat the pathogen in question. This procedure, ethically correct, minimizes the risk that the various pathogens develop resistance to antibiotics.
- In the presence of kidney stones, various techniques are used, ranging from the classic ” splash of water ” to the crushing of these mineral aggregates using shock waves, lasers, or minimally invasive mechanical means (see: cures and treatment of kidney stones ).
- In mild (or first degree) prostatic hypertrophy, therapy is pharmacological (anti-inflammatory, muscle relaxants, inhibitors of the 5-alpha reductase enzyme ).
Therapy: Blood Clots In Urine
Treatment of hemorrhagic cystitis varies according to two factors: the cause of the inflammation and the degree of severity of the condition.
Infectious Hemorrhagic Cystitis: Therapy
In the presence of infectious hemorrhagic cystitis, the following could be used:
- Antibiotics, if the cause of the inflammation is a bacterium.
- Antivirals, if the causative factor of the condition is a virus.
- Antifungals, when the causative agent is a fungus.
With correct therapy, infectious hemorrhagic cystitis tends to resolve in a short time and with a benign prognosis.
Non-Infectious Hemorrhagic Cystitis: Therapy
This article will focus exclusively on the therapy adopted in the presence of hemorrhagic cystitis due to pelvic radiotherapy or chemotherapy. Unfortunately, there is no specific cure for hemorrhagic cystitis due to the aforementioned treatments; the interruption of these treatments, in reality, would solve the problem, but clearly, it is not a viable path as long as the patient needs radiation therapy or chemotherapy.
In the presence of mild hemorrhagic cystitis, the treatment plan can be limited to intravenous administration of fluids, favoring blood clots’ production in urine and its expulsion, and drug therapy based on painkillers medicines to relax the bladder muscles. However, in the presence of severe hemorrhagic cystitis, the treatment has a specific objective: to prevent any blood clots blocking the outflow of blood clots in urine, and preventing urination. To achieve this, doctors may resort to irrigation of the bladder (bladder irrigation) with water or sodium chloride solution, performed using a catheter.
Other Treatments: Blood Clots In Urine
- When hemorrhagic cystitis from radiotherapy or chemotherapy involves a conspicuous blood loss, the patient receives blood transfusions to compensate for the aforementioned loss and control anemia.
- To reduce bleeding, it may be useful to insert drugs such as alum, silver nitrate, or phenol into the bladder ( intravesical therapy ); another substance used for the same reason is hyaluronic acid.
- L ‘ oxygen hyperbaric has proved effective in stopping the hematuria that characterizes hemorrhagic cystitis by radiotherapy.
- Another remedy for blood loss is the embolization of damaged blood vessels; however, it is a complex technique that could have unpleasant side effects.
- When hemorrhagic cystitis is severe, and the bladder’s health is compromised, all the conditions exist for the diseased organ’s surgical removal ( cystectomy ).
- Cystectomy is clearly an extreme solution.