What are the common causes of blood in urine. How is hematuria diagnosed. What are the symptoms of blood in urine. When should you see a doctor for hematuria. How is occult blood in urine detected. What are the risk factors for hematuria. How is blood in urine treated.

Understanding Hematuria: What is Blood in Urine?

Hematuria, or blood in urine, is a condition where red blood cells are present in the urinary tract. This can manifest in two ways: visible blood (gross hematuria) or microscopic blood (microscopic hematuria). While the presence of blood in urine can be alarming, it’s not always a sign of a serious condition. However, it’s essential to understand its causes, symptoms, and when to seek medical attention.

Types of Hematuria

• Gross Hematuria: Visible blood in urine, causing it to appear pink, red, or cola-colored
• Microscopic Hematuria: Blood cells only detectable through urine tests or under a microscope

Can hematuria occur without symptoms? Yes, microscopic hematuria often has no noticeable symptoms and is typically discovered during routine urine tests.

Common Causes of Blood in Urine

Hematuria can result from various conditions affecting the urinary system. Understanding these potential causes can help in early detection and treatment.

Urinary Tract Infections (UTIs)

UTIs are a frequent cause of hematuria, especially in women. Bacteria entering the urinary tract can cause inflammation and bleeding.

Kidney Stones

As stones move through the urinary tract, they can cause irritation and bleeding. The pain associated with kidney stones is often severe and sudden.

Enlarged Prostate

In men, an enlarged prostate can compress the urethra, leading to urinary problems and potentially blood in urine.

Kidney Diseases

Various kidney conditions, such as glomerulonephritis or polycystic kidney disease, can cause hematuria.

Urinary Tract Cancers

While less common, cancers of the bladder, kidney, or prostate can cause blood in urine.

Is hematuria always a sign of cancer? No, while cancer can cause hematuria, many non-cancerous conditions are more common causes.

Diagnosing Blood in Urine: Tests and Procedures

Accurate diagnosis of hematuria is crucial for determining the underlying cause and appropriate treatment. Healthcare providers use various tests and procedures to identify the source of bleeding.

Urinalysis

A urinalysis is often the first step in diagnosing hematuria. This test examines the urine for various components, including red blood cells, white blood cells, and bacteria.

Urine Dipstick Test

The dipstick test for blood is based on the peroxidase-like activity of hemoglobin. When blood is present, the strip changes color from orange to green-blue.

Microscopic Examination

A microscopic examination of urine sediment can confirm the presence of red blood cells and provide additional information about their shape and characteristics.

Imaging Tests

CT scans, ultrasounds, or MRIs may be used to visualize the urinary tract and identify potential causes of bleeding.

Cystoscopy

In some cases, a cystoscopy may be performed to examine the inside of the bladder and urethra for abnormalities.

How sensitive are urine dipstick tests for detecting blood? Urine dipstick tests can detect hemoglobin concentrations as low as 0.015 to 0.062 mg/dL, corresponding to 5 to 21 RBCs/μL of urine.

Risk Factors for Hematuria

Several factors can increase an individual’s risk of developing hematuria. Understanding these risk factors can help in prevention and early detection.

• Age: Men over 50 are at higher risk
• Gender: Women are more prone to UTIs, while men are more likely to develop kidney stones
• Recent infections: Particularly kidney infections in children
• Family history of kidney disease or urinary tract problems
• Certain medications: Aspirin, penicillin, and blood thinners can increase the risk
• Strenuous exercise: Particularly long-distance running

Does exercise always cause hematuria? No, while strenuous exercise can sometimes lead to transient hematuria, it’s not a common occurrence in most people.

Interpreting Urine Occult Blood Test Results

Understanding the results of a urine occult blood test is crucial for proper diagnosis and treatment. This test can detect even small amounts of blood that are not visible to the naked eye.

Normal Results

A negative or low result on a urine occult blood test is considered normal and healthy. It indicates the absence of blood in the urine.

Abnormal Results

A positive result indicates the presence of blood in the urine. However, the significance of this finding depends on the quantity of blood and other accompanying symptoms.

What is considered microscopic hematuria? Microscopic hematuria is typically defined as the presence of 3 or more red blood cells per high-power field in the urine sediment.

False Positive and False Negative Results

It’s important to note that urine occult blood tests can sometimes produce false positive or false negative results. Understanding these potential inaccuracies can help in proper interpretation of test results.

Causes of False Positive Results

• Myoglobin in urine
• Presence of oxidizing agents like bleach or detergent
• Bacterial peroxidase
• Vegetable peroxidase from certain foods
• Contamination with menstrual blood

Causes of False Negative Results

• Expired or improperly stored dipsticks
• High concentrations of ascorbic acid (Vitamin C) in urine
• Very high urine specific gravity
• Highly acidic urine (pH <5.1)
• Certain medications like captopril

Can vitamin C supplements affect urine occult blood test results? Yes, high doses of vitamin C can potentially lead to false negative results on urine dipstick tests for blood.

When to Seek Medical Attention for Hematuria

While not all cases of hematuria require immediate medical attention, certain situations warrant prompt evaluation by a healthcare provider.

Situations Requiring Immediate Care

• Visible blood in urine
• Blood clots in urine
• Persistent hematuria lasting more than a few days
• Hematuria accompanied by pain or burning during urination
• Unexplained weight loss or fatigue along with hematuria

Routine Follow-up

Even if hematuria is discovered incidentally during a routine check-up, it’s important to follow up with additional tests to determine the underlying cause.

Should you always see a doctor for microscopic hematuria? While not all cases of microscopic hematuria are serious, it’s generally recommended to consult a healthcare provider for proper evaluation and to rule out potentially serious conditions.

Treatment Options for Hematuria

The treatment for hematuria depends on its underlying cause. Once the source of bleeding is identified, appropriate interventions can be initiated.

Treating Underlying Conditions

• Antibiotics for urinary tract infections
• Pain management and hydration for kidney stones
• Medications or surgery for enlarged prostate
• Specific treatments for kidney diseases or cancers

Lifestyle Modifications

In some cases, simple lifestyle changes can help manage or prevent hematuria:

• Increasing fluid intake
• Avoiding irritants like caffeine and alcohol
• Quitting smoking
• Maintaining a healthy weight

Can hematuria resolve on its own? In some cases, particularly those caused by strenuous exercise or minor infections, hematuria may resolve without specific treatment. However, it’s important to identify and address the underlying cause to prevent recurrence.

Understanding blood in urine, its causes, and proper diagnosis is crucial for maintaining urinary tract health. While hematuria can be alarming, it’s often a symptom of treatable conditions. Regular check-ups and prompt attention to urinary symptoms can help in early detection and effective management of hematuria and its underlying causes. Remember, if you notice blood in your urine or experience persistent urinary symptoms, it’s always best to consult with a healthcare provider for proper evaluation and guidance.

Urine Occult Blood – Lab Results explained

Urinalysis refers to a series of tests that can be run to assess the chemical quality of urine. Typically, this is done by dipping a strip into the urine sample, and chemical reactions change the color of the pads.

The dipstick test for blood is based on the peroxidase-like activity of hemoglobin. Red cells are lysed on contact with the strip, allowing free hemoglobin to catalyze the liberation of oxygen from organic peroxide. Tetramethylbenzidine is oxidized, producing a color change from orange to green-blue.  If intact red cells do not lyse, they may produce speckles on the pad.

A few notes on reference ranges:

– The reference range for RBCs in normal urine is 0-3 RBC/hpf in males and 0-12 RBCs/hpf in females when concentrated urine sediment is examined. This range corresponds to a concentration of 3 to 20 RBCs/uL of urine. Dipstick sensitivity extends into the reference range. Therefore, trace to 1+ reading may be obtained on urine from as many as 3% of healthy individuals.  

– The sensitivity of dipsticks for hemoglobin is 0.015 to 0.062 mg/dL. This concentration corresponds to 5 to 21 RBCs/uL or 1 to 4 RBCs/hpf of concentrated urine sediment.

——————-

Occult blood is blood that cannot be seen without a microscope. Normal urine doesn’t contain red blood cells, except females’ urine during menstruation. Blood in the urine, called hematuria, is not a normal finding, but it is not uncommon and not necessarily a cause for alarm. Your healthcare professional will investigate further to try to determine the source and underlying cause of the blood.

There are some risk factors that can put you at risk for hematuria such as:

– Age (men older than 50)

– Sex (women with urinary tract infections, men with kidney stones)

– Recent infection (particularly of the kidneys in children)

– Family history

– Certain medications (aspirin or penicillin)

– Strenuous exercise

What does it mean if your Urine Occult Blood result is too low?

A low, or negative, urine occult blood test is normal and healthy, as it indicates that there is no blood in the urine.

—–

False Negative Dipstick:

– Dipsticks exposed to air

– RBCs settle out & urine not mixed

– Ascorbic acid (high concentration)

– Formaldelhyde (preservative tablets)

– High specific gravity

– Very high protein

– Urine pH <5.1

– High nitrite from UTI

– Captopril (Capoten)

What does it mean if your Urine Occult Blood result is too high?

In healthy individuals, fewer than 1000 red cells are excreted in the urine per minute. When 3000 to 4000 red cells are excreted per minute, 2 to 3 red cells will be seen per high power field, indicating microscopic hematuria. Gross hematuria occurs when more than 1 million red cells are excreted per minute. Hematuria can be due to lesions within the GU tract involving the kidneys, ureters, bladder, prostate, or urethra.

The most common disorders include cancer, kidney stones, renal disease, urinary tract infection, and benign prostatic hyperplasia. Transient hematuria can result from menstruation, viral illnesses, strenuous exercise, and mild trauma. Anticoagulant therapy and chemotherapy may also cause hematuria. No etiology can be determined in approximately 45% of cases of microscopic hematuria. 

A positive dipstick test for blood does not tell whether the reaction is due to red cells, red cell casts, hemoglobin casts, or myoglobin. Many conditions can lead to discrepant dipstick and microscopic findings. Any situation that causes red cell hemolysis will give a positive dipstick and negative microscopic result. Urine should be tested shortly after collection because red cell lysis may occur as the sample ages, if the pH is alkaline, or if the specific gravity is 1.010 or less. Bacterially contaminated urine specimens may contain sufficient peroxidase activity to produce a false positive reaction. False positive reactions can also be caused by vegetable peroxidase.

False Positive Dipstick:

– Myoglobin

– Oxidizing agents – bleach, detergent, iodine

– Bacterial peroxidase

– Vegetable peroxidase

– Betadine

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Occult Blood In Urine: What This Means

Occult blood is when you can’t see blood in your urine with your eye and it’s only visible under a microscope. You may need antibiotics or different treatments depending on the infection or other causes.

Being told you have blood in your urine can be concerning, especially if you cannot see the blood.

In medicine, the word “occult” means “hidden. ” Occult blood in the urine means the blood in the urine is only visible under a microscope.

Here’s what you need to know about this test result, what conditions may cause it, and what additional testing you may encounter.

The medical term for blood in the urine is hematuria.

Blood in the urine may be tinged pink or red. When you can see it, this is considered gross hematuria.

When blood is in the urine but you cannot see any pink, red, or clotting, it’s considered occult blood. Another name for this condition is microscopic hematuria.

Doctors typically divide microscopic hematuria into categories depending on how much blood is found in the urine under the microscope (microscopy).

• Significant microscopic hematuria: 3 or more red blood cells (RBC)/hpf (≥ 3 RBC/hpf)
• Insignificant microscopic hematuria: 2 or fewer RBC/hpf (0-2 RBC/hpf)

Significant microscopic hematuria warrants further testing.

Readings in the insignificant category do not necessitate further testing unless symptoms or other issues develop.

There are numerous reasons you may have blood in your urine. Some involve health conditions, like infection or cancer, and others relate to certain activities or even trauma.

Causes include:

• bladder infection
• kidney infection
• other infections (urethra, prostate, etc.)
• stones in the urinary tract
• benign prostatic hyperplasia (BPH)
• endometriosis
• trauma

Blood in the urine may also be caused by more serious issues:

• bladder cancer
• kidney cancer
• prostate cancer
• hemophilia and other blood-clotting disorders
• sickle cell anemia
• kidney disease (with involvement of the glomeruli)

Dehydration may also lead to blood in the urine.

When this happens, it’s considered a false positive result because it does not relate to disease. Other causes of false positives in a urine dipstick test (a type of urinalysis) include:

• hard exercise
• the presence of menstrual blood in the sample
• recent sexual activity
• free hemoglobin or myoglobin

Doctors and labs use a few different tests to look for blood in the urine.

Urinalysis (microscopic exam) is usually the first test you’ll encounter after a dipstick test. In this test, you’ll be asked to urinate in a cup. You’ll need to do a “clean catch” and follow the instructions closely to ensure your sample isn’t contaminated. The lab will then look closely at the sample under a microscope.

Additional testing may include:

• blood tests to look for kidney issues, autoimmune diseases, or cancer
• cystoscopy, which uses a small camera to gather pictures inside the urinary tract
• kidney biopsy to evaluate tissue for disease or damage
• imaging tests to visualize issues with the bladder, kidneys, and other organs
  • computed tomography (CT)
  • magnetic resonance imaging (MRI)
  • ultrasound

What if you get a false positive or negative test result?

False positive test results for occult blood in the urine are relatively common (22%) with dipstick testing.

To be a true false positive, a microscopy test must also be negative. False negatives are less common (4%).

Diet, exercise, medications, and hydration may all affect test results. If you have concerns about your results, ask your doctor if a re-test may be warranted.

The treatment for blood in the urine depends on the underlying cause.

For example:

• infection may be treated with antibiotics
• dehydration may be treated by giving fluids
• enlarged prostate may be treated with medication
• bladder or kidney stones may be treated with sound waves (lithotripsy)

In cases where the blood is caused by benign things — like exercise or menstrual blood — no treatment may be necessary.

You may have blood in your urine even if you cannot see it. If your doctor tests your urine and the test comes back positive for hematuria, you may or may not need further testing.

The next steps hinge on how much blood was found in the urine and what other symptoms you’re experiencing.

BDO Quests: Blackstar Weapons quest chain

How do I get Blackstar’s main weapon? You have to go through a separate quest chain. To start the quests for the main weapon of the Black Star, you need to knock out a new item from the Rift of Darkness Rift Mark (low drop rate). The rift trace can also be purchased at the auction. In addition, you must have the knowledge “Media, three blacksmiths”, this knowledge can be obtained at level 56 and above after completing the “3 blacksmiths” quest from the NPC Tullem.

Quests to obtain Black Star’s main weapon can only be completed once per character.

Once you have the Rift Mark, right-click on it in your inventory.

Martha [Blackstar Weapon] Rift Marks
Meet a person very interested in unknown liquids. Go to Archaeologist Martha at the Northern Wheat Field.
Reward: Combat EXP (100), Influence EXP (20)

Marta [Black Star Weapon] Forbidden Region
Find Martha who went to Star’s End
Deliver unknown liquid to Martha who went to Star’s End
Reward: Combat EXP (100), Influence EXP (20)

Marta [Black Star Weapon] Huge Black Meteor on the mark, interact with the meteorite
Take a piece of the black meteorite, go to the second mark and interact
Give Martha a bottle of powder
Reward: combat experience (100), influence experience (20)

Marta [Black Star Weapon] Suspicious Simultaneous Death
Collect suspicious blood, follow the mark to the Dark Energy Cow and interact
Donate blood to Marta
Reward: combat experience (100), influence experience (20)

900 09 March [Blackstar Weapon] Suspicious Blood Investigation
Transfer Blood to Gorgas
Reward: Combat EXP (100), Influence EXP (20)

Alchemist Gorgas [Blackstar Weapon] Essence of Blood?
Research blood with Gorgas. Talk to Gorgas (to analyze the blood together).
Reward: Combat EXP (100), Influence EXP (20), Gorgas Amity (10)

Alchemist Gorgas [Black Star Weapon] Unknown Admirer
Defeat a monster possessing dark energy. Immediately a monster appears, kill him.
Reward: combat experience (100), influence experience (20), friendship points Gorgas (20)

Alchemist Gorgas [Black Star Weapon] Old Book of Caphras
Find the Caphras Research Log. We leave for the Cave of Caphras (Kalpheon), run deep and break the Ancient Gates. We find there the ancient book of Caphras.
Reward: Combat EXP (100), Influence EXP (20), Gorgas Friendship Points (10)

Ancient Book of Caphras [Blackstar Weapon] Alchemist’s Tongue
Listen to information about Blackstar. We return to Gorgas.
Reward: Combat EXP (100), Influence EXP (20), [Knowledge] Ancient Book of Caphras

Alchemist Gorgas [Black Star Weapon] Black Star
Listen to information about the Caphras research journal. We communicate with Gorgas (Source of black death).
Reward: combat experience (100), influence experience (20), Red eye.

Here you will have the choice of “Dead Spirit Altar” or “To Tariffa Village”

Option 1.

If you chose “Dead Spirit Altar” you will need to kill the summoned boss, he is very fat, he needs an attack 260+, but you will get more reward.

Option 2.

If you chose “To Tariffa Village” you will need to kill the weakened summoned boss and 1000 monsters of the Tugu clan.

Black Spirit [Black Star Weapon] To Tariff Village
Meet Gorgas.
Reward: combat experience (100), influence experience (20).

Alchemist Gorgas [Black Star Weapon] How to deal with evil energy
Go to Ellan Servin.
Reward: combat experience (100), influence experience (20).

Trainer Ellan Servin [Blackstar Weapon] Plate with 9 magic power0010
Collect the Ancient Baut Slab. Kill 1000 Tugu.
Give the Eye of Darkness to Ellan Servin.

In order to get the Eye of Darkness, you need to combine in the tab L – Craft weapons:
1 Red Eye + 3 concentrated energy of the summoned monster boss (Kzarka, Nuber, Kutum, Karanda).
Reward: Weakened Eye of Darkness.

Reward: Weakened Eye of Darkness, Combat Experience (100), Elan Servin Friendship Points (10)

Black Spirit [Black Star Weapon] On the Altar of the Dead God into the brazier. We leave for the brazier of the Star’s tomb.

Reward: Combat EXP (100), Influence EXP (20), Black Star Talon, Treasures of Injustice Incarnate

Star’s End Brazier [Black Star Weapon] A relic left from Black Star?
Talk to Kanobas
Reward: Combat EXP (100), Influence EXP (20)

Weapon Master Canobas [Black Star Weapon] Legendary Mediah Blacksmith
Talk to Varatan Lanso
Reward: Combat EXP (10 0), experience Influence (20)

Waratan Lanso Node Control [Blackstar Weapon] Mainland’s Best Blacksmith
Talk to Thorin Morgrim
Reward: Combat EXP (100), Influence EXP (20)

Blacksmith Thorin Morgrim [Weapon Black Star] Strength of the Ancient Ator
Hand over the Claw of the Black Star
Activate the Ancient Power
Approach the crystal ball behind Morgrim and close the quest.