Synopsis
Stabilise significant urinary bleeding, distinguish glomerular from urological sources and apply current cancer, infection, stone and nephrology pathways to visible or persistent non-visible haematuria.
- First decide whether blood is visible or detected on reagent strip, painful or painless, and accompanied by clots, infection, obstruction or physiological instability.
- Confirm that red urine is blood: beetroot, rifampicin, porphyria, haemoglobin and myoglobin can change colour or the dipstick result. Menstrual or genital bleeding may contaminate a sample.
- Painless visible haematuria is a urinary malignancy signal until appropriately investigated. Anticoagulants and antiplatelets can increase bleeding but do not remove cancer or stone risk.
Key red flags
Fresh dark-red urine, clots, inability to void, suprapubic pain, blocked catheter, haemoglobin fall or circulatory compromise indicates clinically important bleeding and possible clot retention.
Investigation priorities
Confirm haem pigment, detect infection and protein, and assess renal sediment when indicated.
Management branches
Clots, retention, catheter blockage, haemoglobin fall, heavy ongoing haematuria or instability.
- Perform ABCDE, obtain IV access, FBC, group and save/crossmatch, renal profile and coagulation, and review antithrombotic indication with senior help.
- If clot retention is present and urethral injury is not suspected, involve urology for an appropriate large-bore three-way catheter, manual washout and continuous irrigation under local practice.
Incidental reagent-strip blood in a clinically stable patient.
Key medicines
Anticoagulant or antiplatelet reviewContinue, interrupt or reverse only after assessing bleed severity, timing, renal clearance and the original thrombotic indication with the relevant senior pathway.
Antibiotic for culture-supported urinary infectionChoose from current local and NICE guidance using infection site, sepsis severity, prior cultures, allergy, pregnancy and renal function.