What do occult blood 1+ and RBC 3-5/HPF in urine mean, and …

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    A test strip says you got 1+ blood and a follow-up microscopic confirms that you have 3–5 RBC’s per High Power Field.

    It may be normal in a women if she was just beginning or ending her period … All others need a repeat urinalysis to see if RBC’s are still there. If so, then we have to find out where they are coming from.

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    While in many instances the cause is harmless, blood in urine (hematuria) can indicate a serious disorder. Blood that you can see is called gross hematuria. Urinary blood that’s visible only under a microscope (microscopic hematuria) is found when your doctor tests your urine.

    Microscopic examination/urine sediment. WBCs, RBCs, epithelial cells, and, rarely, tumor cells are the cellular elements found in the urinary sediment. The number of WBCs considered normal is typically 2-5 WBCs/hpf or less. … Gross hematuria is the presence of red/brown urine.

    In general, more than 3-5 red blood cells per high power field on microscopic urinalysis is concerning, especially in people over age 40.

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    Both or these are findings in a urinalysis. Occult means hidden. This is blood that isn’t visible to the eye but that is detectable by testing for it and is visible under a microscope. In urine dipstick testing, 1+ and above indicates significant hematuria, blood in the urine. A trace amount is a negative result. RBCs, or red blood cells, are seen in a microscopic urinalysis, when the specimen is examined under a microscope. Generally speaking, more than 3–5 RBCs per HPF is concerning. And, no, these results aren’t normal but I don’t believe the results given should be alarming but they do merit attention. Lots of things cause hematuria, I can’t emphasize that enough, including strenuous exercise and minor trauma, even trauma from masturbation. I’m not going to get into explanations of power fields and microscopes — you can look into that on your own time, if you care to.

    In the future, please review test results with the ordering physician instead of posting them online and asking the general public. It’s a distinct mistake to post test results online and ask for interpretation. I strongly suggest you refrain from doing this again.

    If the occult blood 1+ result is in urine, it is because of the 3–5 rbcs/hpf. It is not so high but if it is continuing, further tests and physical exam to be done. I do not know that the urine is from a female or male.

    It means you should see a clinician as soon as possible for their opinion.

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    Well, sorta depends.

    Really, you don’t want any. The presence of pus cells, even 1/hpf, indicates an active, bacterial infection. What you want the pathologist to see is no pus cells at all.

    Pus cells are neutrophilic leukocytes that are normally confined to the blood but migrate to sites of infection and in some cases, inflammation. Normal, healthy, uninfected tissue has no pus cells ever. The presence of even a few, rare neutrophils in extracorporal ( away from blood) tissue is pathologic and indicative of an infection that requires treatment.

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    Not exactly.

    In urine, you normally expect little to no red blood cells. In this context, it would mean 0–2 red blood cells per high powered field. When you start seeing amounts like this you start to question whether the person was doing strenuous exercise (if they’re there for routine or pre-op lab work), or if it could mean something more serious, like a bleed or kidney disorders.

    However, leave the interpretation of your results to your doctor, since they’ll have a more complete picture about your medical history.

    Hope this helps.

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    Many things can cause hematuria (blood in urine) and we typically classify hematuria as being painful or painless. Here’s a list of some reasons but not all reasons :

    1. strenous exercise- if you have little (perinephric) fat and go run a marathon your kidneys are bouncing around in your retroperitoneum and this can cause trace blood in urine.
    2. Kidney stone – stones irritate the ureters and cause blood in urine. This is a painful cause of hematuria
    3. bladder cancer – painless hematuria, usually men 60s or older with a history of tobacco smoke
    4. urinary tract infection – when lining or your urinary system is inflamed from infection (or non infectious causes) you can have blood in your urine
    5. anticoagulation- many many people take drugs that thin their blood and or block production of platelets (ie- aspirin, plavix, Coumadin, xaralto, lovinox, etc) and all these meds can cause you to bleed in your urine
    6. trauma – sex can injure the urethra and lead to hematuria , more severe trauma like pelvic fracture leading bladder rupture or urinary tract injury
    7. foley insertion – like sex this can also be traumatic to urethra if not done correctly
    8. Medications – meds like ibuprofen , Motrin , naproxsyn and other NSAIDs are all nephrotoxic if used for prolonged periods and can cause parenchymal damage leading to hematuria
    9. rhabdomyelisis- muscle breakdown caused by severe over use , dehydration, cocaine use, meds can cause hematuria or mimic it because of the myoglobin released by crushed/injured myocytes
    10. polycystic kidney disease- genetic disorder that causes people to have many cysts on their kidneys (and liver) cysts can be hemorrhagic and lead to hematuria

    Blood in the urine (called hematuria) is abnormal. There are various etiologies of microscopic (seen only under the microscope) and/or gross hematuria (seen with the nake eye) including benign essential hematuria , urinary tract infection, stone, or possible malignancy. The most common cause identified for asymptomatic microscopic hematuria is “benign essential hematuria”. This means that the kidneys are simply losing some red blood cells into the urinary tract. Urinary tract infection can cause irritation in the bladder causing microscopic hematuria . Kidney cancer and/or bladder cancer can also present as microscopic blood or gross blood. Smoking dramatically increases the risk of developing a tumor in the urinary tract. A stone in the urinary tract can rub the inside of the urinary tract resulting in microscopic or gross hematuria. Evaluation for the possibility of all of these etiologies should be done. However, the only way to diagnose benign essential hematuria is to prove there is no significant stone, tumor, or urinary tract infection. Urine cytology, CT of the abdomen and pelvis or intravenous pyelogram or renal ultrasound, and cystoscopy are the tests to determine the diagnosis.

    *EDIT: This question said it needed “attribution” – this is the standard information given to patients in our practice.

    If you aren’t close to your period, then we can assume the red cells came from your urinary system. That can be from inflammation of the bladder, parasites exiting through the bladder wall (Schistosoma), free hemoglobin from a hemolytic anemia, bladder cancer, kidney stones, prostate cancer, urethritis from STD’s. Why don’t you see a doctor and let him help you sort it all out.

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    In a young male or postmenopausal female, it is probably significant. In all others, it may be significant and should be ruled out or in by further history where it might be coming from.

    If they have a bladder infection (UTI), then clear it up and repeat the UA (urinalysis) test 2 weeks after the last dose of antibiotics. If they are still there (3–5) then further work needs to be done.

    If they are close to the end of their menses (period), then a repeat UA in 2 weeks should show no red cells … if they still have red cells, it needs further work-up.

    There are lots of reasons for red cells in the urine and some are “normal siting’s” and some are pathologic. My postmenopausal wife had a kidney removed and didn’t need CHEMO because her doctor took 3–5 red cells that repeated as something to look into. An ultrasound got her a trip to a urologist where they biopsied it and watched it’s growth until 7 mm. at which time it was “actionable” by Medicare rules.

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