Urine Erythrocytes (Red Blood Cells) test is a kind of laboratory test that determines the presence of RBC.
This test is a Urinalysis and helps to diagnose the Blood in the Urine.
Often, it is done in routine “Complete Urine Examination” test with other parameters such as Leukocyte, Ketone, Urobilinogen, Bilirubin, Glucose, Protein, pH.
Certain diseases cause Urinary Tract Infiltration from the Urinary System or Kidneys, and therefore RBC’s are positive in the Urine assay.
Blood (Erythrocyte) is seen in the Urine and it is called Hematuria.
Under normal conditions, Erythrocytes are not present in Urine.
However, it is considered normal to see 1-2 Erythrocytes in the large enlargement microscopic area called HPF, but in the case of 3 urine samples taken 1 week, 5 or more Erythrocytes in the HPF after centrifugation are called Hematuria.
It can be frightening to see Blood in your Urine, but most of the time the Hematuria does not pose a life threat. However, it is important to investigate the cause of Hematuria because it is sometimes due to a serious situation.
The presence of Erythrocytes in urine does not always mean the presence of an illness. Transient and insignificant positivity of Erythrocytes can occur some situations such as ;
Benign Familial Hematuria
Drug use (Amphotericin, Oral Anticoagulants, Heparin, Aspirin, Bromo-copper-iodinated drugs, Oxidant drugs)
Heavy exercises and
Contact from Menstrual Blood.
Hematuria may be Macroscopic (Urine color is Red, Tea color) or Microscopic (only visible on a Microscope), transient or permanent, symptomatic or asymptomatic (no complaint), isolated or with Proteinuria.
Causes of Hematuria ;
The most common causes of Hematuria are usually ;
Cystitis (20-25 %)
Urinary Tract Stones
Urethral Stones and
What is Hemoglobinuria ?
In a full urine test, Hemoglobin is detected in Erythrocytes, sometimes not in stable urine, which is called Hemoglobinuria.
It is usually due to extraneous causes (intravascular Hemolysis) but may also occur when Erythrocytes are destroyed in the Urinary System.
Clinical evaluation of Hemoglobinuria and Hematuria can be done with both dipstick (strip stick) and microscopic examination of Urine.
What is Myoglobinuria ?
If the strip test is positive but there is no Erythrocyte in the microscope, Myoglobinuria and Hemoglobinuria are suspected.
Myoglobin that carry oxygen in the Muscles and can be passed to Urine in all kinds of Muscular diseases and injuries.
Where Does The Blood in The Urine Come From ?
Red Blood Cells determined by Urine Analysis can be caused by Kidneys, Ureters, Bladder or Urethra. These organs can bleed and pass urine Erythrocytes.
How Is The Test Done ?
A random Urine sample is used for the Urine Erythrocyte test. This can be given at any time of day. However, urine samples should not be taken during Menstruation in Women.
When giving Urine, middle stream Urine is preferred, that is, the patient makes the first Urine in the toilet and the middle part of the Urine is collected in the sample vessel.
Women can use a handkerchief to clean the Labia and Skin around the Urethra.
The report is preceded by a macroscopic appearance (Urine color, Blur, Smell ..).
Then Strip test should be done. Color change is positivity and it is called Erythrocyte or Hemoglobin. In new strips, the presence of solid Erythrocytes can be detected with dotted color change.
The urine is then centrifuged and examined microscopically. Hemoglobinuria is suspected if there is no Erythrocyte or if there is not enough to describe the color change of the strip.
In urine cherry red color, no Erythrocyte and enzymes that can show Muscle damage such as AST, ALT, Aldolase, CK are suspected to be calm high Myoglobinuria.
Reasons of Erythrocytes (Blood) in Urine :
Acute Urinary Tract Infections (such as Cystitis)
Urinary Tract or Kidney Cancers
Uriner Stones (Intermittent Hematuria)
Polycystic Kidney Disease
Benign Familial or Recurrent Hematuria (no complaints, no proteinuria, no other findings)
Reasons of Hemoglobinuria :
Transfusion Reactions (improper Blood transfusion, Medication dependent ..)
Chemical Agents (some Mushrooms, Snake Venom)
Bleeding during Prostate Surgeries
Hemolytic Diseases (Sickle Cell Anemia, Thalassemia, G6PDH Deficiency)
Paroxysmal Hemoglobinuria (Hemoglobin appears at irregular intervals)
Renal Infarction (Necrosis with vascular occlusion, decay)
Allergy to Broad Been (severe Hemolysis)
DIC (Disseminated Intravascular Coagulopathy)
What Does Mean “Low Erythrocytosis” in The Urine ?
Erythrocytes is not normally seen in the Urine, so there is no such thing as low.
It just happens to be lower than its previous highs, which is a good thing.
Causes of False Positive Erythrocyte in The Urine ?
Amphotericin, Oral Anticoagulants, Heparin, Aspirin, Bromo-copper-iodinated drugs, Oxidant drugs.
Excess Meat Consumption
The presence of Red Pigments
Beetroot, Food stains, or drugs such as Phenazopyridine /Pyidium) in the Urine.
Causes of False Negative Erythrocyte in The Urine ?
Vitamin C (Ascorbic acid)
High Urine Specific Gravity
Abundant Erythrocytes from Menstruation can be seen but normal.
What is The Indication of Erythrocyte Positivity in The Urine ?
This entirely depends on the cause of the event.
Kidney, Bladder and Urinary Tract Infections can cause fever, burning and painful Urination.
Other Hematuria symptoms; Abdominal pain, frequent Urination and Dizziness.
There are no complaints such as Benign Hematuria, Drug use, Heavy exercises and after Menstruation, occasionally Erythrocytes are detected by chance.
How is The Urine Report Evaluated, What is Erythrocyte 1+, 2 ++, 3 +++ or 4 ++++ in Urine ?
If there is no Erythrocyte in the Urine, it is called negative and it means that there is no Blood in the Urine.
The presence of WBC and RBC in urine is reported by the amount of cells in the Urine.
The presence of Red Blood Cells can be reported as positive; +, ++, +++ (3 plus sign means more Erythrocytes in Urine).
But the best thing is to score in the microscope field. For example, a report “4-5 Erythrocytes were seen in each area” gives more detailed information.
Erythrocytes Positive in The Urine, Which Tests Are Done ?
There are a number of tests available to determine the cause of Hematuria. Most people do not need every test.
Blood tests can be used to find evidence of other diseases that can cause Kidney or Hematuria.
Computed Tomography or CT scan is a Radiological test that examines the structure of the Kidneys, Ureters, and Mesentery.
Renal Stones or Renal, Ureter, and Bladder abnormalities can usually be seen with a CT Scan.
Kidney Ultrasound is an alternative to CT Scanning and is preferred for people with pain allergies used in CT. Ultrasound uses sound waves to see the Kidney.
A small tube with a Camera is placed on the Cystoscope through the Urethra. During Cystoscopy, the Doctor examines the Bladder to determine if there is any abnormality.
Biopsy can be done if abnormal tissue is seen. A Biopsy is the staining and examination under a microscope to determine if abnormal or Cancerous cells are present.
During Kidney (Renal) Biopsy, the Doctor removes a small piece of tissue from the Kidney and the Pathologist examines it.