Erythrocytes are blood cells that are responsible for the transport of hemoglobin to body tissues. Normally, these cells are found only in the bloodstream and should not go beyond it. But there are pathological conditions in which they enter the urine. What does the presence of unchanged red blood cells in the urine indicate? And how to deal with this problem? This is detailed in the article.
What does the term "hematuria" mean?
Hematuria is the presence of blood cells in the urine. But not always their presence is called by this term. Scientists have found that more than 2 million red blood cells enter the urine per day. But laboratory tests will characterize this figure differently. When examining urine using microscopy, the norms of erythrocytes in the urine are as follows:
- women - up to three RBCs per field of view;
- men - up to two RBCs per field of view;
- newborns - two to four cells per field of view.
Therefore, hematuria is considered the appearance of unchanged erythrocytes in the urine in women in the amount of 4 or more in the field of view, in men - 3 or more.
By the number of cells in the urine, hematuria is divided into two groups:
- gross hematuria - 50 or more red blood cells are found in the field of view, the color of the urine is changed to red or brown, or there is a drop of fresh blood at the end of urination;
- microhematuria - the color of urine is not changed, less than 50 erythrocytes in the field of view are determined by microscopic examination.
Pathogeny of hematuria
Pathogenesis is a step-by-step description of the development of a certain disease. Knowing how altered and unchanged red blood cells appear in the urine will help in understanding the symptoms and treatment of hematuria.
Erythrocytes enter the urine through one of the following mechanisms:
- When the wall of the membrane of the capillaries that supply blood to the kidneys is damaged. Their structure can be destroyed due to trauma, inflammation, tumor growth.
- With stagnation in the veins of the small pelvis that occurs with phlebitis, external compression of the veins by pathological neoplasms.
- In violation of the structure of the urinary system: ureters, bladder, urethra. Develops with inflammation of the mucous membrane of these organs.
The presence of unchanged red blood cells in the urine indicates that the pathology is below the level of the kidneys. That is, the ureters, bladder or urethra are affected. And if in the general analysis of urine the presence of alterederythrocytes, it is worth suspecting the pathology of the kidneys themselves. This is due to the fact that with kidney disease, the erythrocyte changes its structure, passing through the capillary membrane.
Causes of hematuria
The presence of unchanged red blood cells in the urine does not necessarily indicate any pathology. They can enter the urine for the following physiological reasons:
- excessive exercise;
- chronic stress;
- alcohol abuse;
- prolonged exposure to the sun or in the bath, which led to overheating of the body.
But in the vast majority of cases, the cause of increased unchanged red blood cells in the urine are diseases:
- acute or chronic cystitis - inflammation of the bladder;
- urolithiasis;
- acute or chronic urethritis - inflammation of the urinary tract;
- abdominal trauma with damage to the organs of the urinary system;
- prostate adenoma or prostatitis in men;
- gynecological diseases in women - uterine fibroids, cancer of the body or cervix, bleeding from the organs of the reproductive system;
- blood clotting disorder - hemophilia, idiopathic thrombocytopenic purpura.
Causes of altered red blood cells in urine
As noted above, altered erythrocytes in urine indicate the pathology of the kidneys themselves. Violation of the structure of the renal capillaries cause such diseases:
- glomerulonephritis - autoimmune inflammation of the glomerulirenal capillaries;
- TB kidney disease;
- oncological neoplasms;
- pyelonephritis - inflammation of the kidneys of a bacterial nature;
- autoimmune vascular disease (hemorrhagic diathesis);
- taking drugs that are toxic to the body - sulfonamides, anticoagulants;
- prolonged increase in blood pressure.
Clinical manifestations
The fact that unchanged erythrocytes in the urine are elevated does not yet give grounds for making a specific diagnosis. The final cause of hematuria is determined in accordance with the clinical manifestations and data from other diagnostic methods of examination.
Elevated unchanged red blood cells in the urine are not always accompanied by symptoms. Allocate asymptomatic, or painless, hematuria. It most often occurs suddenly. It is the excretion of large blood clots along with urine. There are no pains or other unpleasant symptoms. In this case, the first step is to rule out a bladder or kidney tumor.
Also, hematuria can occur with violent symptoms. The release of blood is accompanied by severe pain in the lower abdomen or in the lumbar spine. There may be an increase in temperature and a deterioration in well-being. Urine is excreted in small portions. In this case, the patient most likely has urolithiasis.
Elevated unchanged red blood cells in the urine are a common sign of cystitis in women. Then hematuria is accompanied by constant urge to urinate, burning during it. The amount of urine is small, blood comes out in drops at the end of urination.
The approximate source of bleeding can be determined by the shape of the blood clot. If it has a worm-like shape, then the erythrocyte has passed through the ureter. That is, the source of bleeding must be sought in the kidney or directly in the ureter.
Un altered red blood cells in the urine of a child
Hematuria in adolescence often appears as a result of infectious diseases of the urinary system. Young girls often suffer from this problem. If hematuria is accompanied by a deterioration in the general condition, an increase in body temperature, pyelonephritis or cystitis should be suspected.
But the appearance of unchanged erythrocytes in the urine of a child in the first months of life does not always indicate pathology. The number of fetal erythrocytes during intrauterine development is increased, and at birth they begin to massively disintegrate. Therefore, microhematuria in a newborn is normal.
The value of a three-glass sample
If the doctor found unchanged red blood cells in the urine, the next step is to determine the level of the lesion. This is where the three-glass sample comes in.
Before it is performed, the patient should refrain from urinating for 3-5 hours. The patient urinates into three containers alternately. At the same time, about 1/5 of the total volume of urine is collected in the first container, 3/5 in the second, and the remaining volume in the third. Urine is immediately sent to the laboratory for analysis.
Results are interpreted as followsway:
- The presence of blood in the first portion and its absence in the subsequent volume of urine indicates the presence of a source of bleeding in the urethra (urethra).
- Hematuria, which is found only in the final portion of urine, indicates the presence of pathology in the bladder or prostate disease in men.
- If erythrocytes are found in all portions of urine, they speak of a disease of the kidneys or ureters.
- Hematuria in the first and last portion, as well as the absence of red blood cells in the second glass, most likely indicates damage to the prostate and urethra at the same time.
Additional diagnostic methods
Determining the cause of unchanged red blood cells in the urine is almost impossible without additional examination of the patient. Most often, the doctor prescribes the following diagnostic methods:
- Ultrasound examination - helps to diagnose urolithiasis, kidney disease.
- Cystoscopy is a method for diagnosing diseases of the bladder, which consists in examining its mucous membrane using a microscopic camera.
- Urography with the introduction of contrast is an X-ray method for diagnosing diseases of the urinary system.
- Scintigraphy is a method of examining internal organs using radioactive isotopes. Used when a tumor is suspected.
- Computed tomography is an X-ray method that allows you to see the structure of internal organs and their relationship to each other with high accuracy.
Any ofthe methods of examination listed above are not routinely prescribed. Only a doctor can issue a referral!
Differential Diagnosis
Answering the question of what it means - unchanged red blood cells in the urine, it is worth noting that their presence does not necessarily indicate a pathology of the urinary system.
In women, the appearance of blood in the urine may indicate menstruation. Urine color will help distinguish menstrual blood from true hematuria. During menstruation, urine remains light, and if there is a pathology of the urinary organs, it becomes cloudy or burgundy.
There is also a condition called urethrorrhagia. In this case, blood flows from the urethra constantly, and not just when urinating. Urethrorrhagia may occur with severe diagnostic or therapeutic interventions (catheterization, bougienage of the urethra), trauma to the urethra.
Hemoglobinuria and myoglobinuria: what is it?
A condition similar to hematuria is called hemoglobinuria. It is manifested by the ingestion of hemoglobin in the urine. It develops with a strong destruction of red blood cells inside the vascular bed with the release of hemoglobin. This condition may be caused by the following situations:
- Hemorrhagic shock during transfusion of incompatible blood by group or Rh factor;
- hydrogen sulfide poisoning;
- severe infectious diseases;
- hemolytic anemia of hereditary or acquired nature;
- major burns.
Dark red color of urine can occur when myoglobin enters it. Myoglobin is a protein that is formed during the breakdown of skeletal muscle. This situation often occurs in people who have been under landslides for a long time. This is called the long-term compression syndrome. Myoglobin accumulates in the tubules of the kidneys and damages their function.
Treatment methods
Therapy for unchanged erythrocytes in the urine largely depends on the cause of the pathology. Conventionally, all treatment can be divided into medical and surgical.
Drug treatment is used for infectious inflammatory diseases of the kidneys, bladder and urethra. So, pyelonephritis, uistitis and urethritis are treated with antibacterial drugs.
For more serious pathologies, they resort to surgical intervention. For example, the appearance of neoplasms requires their prompt resection. The rapid growth of the tumor can lead to damage to the function of the organ. In this case, it will require its complete removal.
The presence of unchanged red blood cells in the urine is a versatile symptom that can be a manifestation of many diseases. Therefore, if during urination you find a change in the color of urine or the appearance of fresh blood clots, do not hesitate, contact a specialist!
