Normal urine contains a small number of red blood cells (RBCs), usually too small to be detected by routine chemical dipstick testing or microscopic urinalysis. Hematuria—blood detected by routine methods—may be visible to the eye (gross or frank hematuria) or invisible (microscopic hematuria). The appearance of blood in a patient's urine often motivates the patient to come to the emergency department with a presenting symptom of gross hematuria. Microscopic hematuria is usually detected in the course of evaluating other symptoms. Hematuria may be associated with pain during urination and often accompanies urinary tract infections. Painless hematuria is more often due to neoplastic, hyperplastic, and vascular causes. Gross or microscopic hematuria warrants an attempt at definitive diagnosis, since underlying disease can be found in a substantial percentage of cases. The emergency physician's task is to rule out a life-threatening cause, make a diagnosis if possible, initiate treatment, educate the patient, and ensure continued appropriate treatment, disposition, follow-up, and referral.
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