What Does “Erythrocyte Positive” Mean in Urine Test ? & Causes of Erythrocytes in Urine

Urine Erythrocytes (red blood cells) test is a kind of laboratory test that determines the presence of RBC (red blood cell).

This test is a urinalysis and helps to diagnose the blood in the urine.

Often, it is done in routine “full urine analysis” 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 red blood cells 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 proteinuria.

The most common causes of hematuria are usually cystitis (20-25 %), kidney stones, renal tuberculosis, renal tumors, renal infarction, acute glomerulonephritis, urinary tract stones, bladder tumors, bladder tuberculosis, bladder stones, urethral stones and urethritis.

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.

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 as a 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 streaks, 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 ?

Prostate growth

Prostate cancer

Acute urinary tract infections (such as cystitis)

Lupus nephritis

Urinary tract or kidney cancers

Uriner stones (intermittent hematuria)

Malignant hypertension



Kidney trauma

Polycystic kidney disease



Heavy exercises

Benign familial or recurrent hematuria (no complaints, no proteinuria, no other findings)

Reasons of Hemoglobinuria ?

Large burns

Transfusion reactions (improper blood transfusion, medication dependent ..)

Febrile intoxication (high fever height)

Chemical agents (some mushrooms, snake venom)


Bleeding during prostate surgeries

Hemolytic diseases (sickle cell anemia, thalassemia, anemia of G6PDH deficiency)

Paroxysmal hemoglobinuria (abdominal hemoglobin appears at irregular intervals)

Renal infarction (necrosis with vascular occlusion, decay)

Allergy to broad been (severe hemolysis)

DIC (disseminated intravascular coagulopathy)

Heavy exercises

What Does Mean “Low Erythrocytosis” in The Urine, What Are The Reasons ?

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.

Test Influencers

Drugs (amphotericin, oral anticoagulants, heparin, aspirin, bromo-copper-iodinated drugs, oxidant drugs) and excess meat consumption can cause false positives.

The presence of other red pigments (beetroot, food stains, or drugs such as phenazopyridine / pyidium) in the urine is also a reason of false positivity.

Vitamin C or ascorbic acid, captopril, finasteride, high-grade urine, proteinuria can make false-negative urine.

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 in painful urine and urine.

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 Are 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

Blood tests can be used to find evidence of other diseases that can cause kidney or hematuria.

CT scan

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

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.

Kidney biopsy

During kidney (renal) biopsy, the doctor removes a small piece of tissue from the kidney and the pathologist examines it.



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