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Hemoglobin in urine: what can it indicate and how to treat it

Hemoglobin in the urine, scientifically called hemoglobinuria, occurs when red blood cells destroy themselves and are eliminated through the urine, giving urine a reddish and transparent color.

However, the presence of hemoglobin in the urine does not always cause symptoms and is only detected by chemical examination with a test strip or microscopic examination and should be treated as soon as possible by an urologist.

Hemoglobin in urine can occur in children, adults and even during pregnancy, due to kidney infections, kidney stones or serious kidney disease, such as pyelonephritis or cancer, for example. Sometimes at the same time as hemoglobinuria, hematuria also occurs, which is urine with blood and it is necessary to go to the doctor to analyze the cause. 

Hemoglobin in urine: what can it indicate and how to treat it

Causes for hemoglobin in urine

There is usually no hemoglobin in urine, and when this occurs the causes can be:

  • Kidney problems, such as acute nephritis or pyelonephritis;
  • Severe burns;
  • Kidney cancer;
  • Malaria;
  • Reactions to transfusion;
  • Tuberculosis of the urinary tract.
  • Sickle cell anemia;
  • Strenuous practice of physical activity;
  • Uremic Hemolytic Syndrome.

In addition, it may be due to excessive cold or nocturnal paroxysmal hemoglobinuria, which is a rare type of hemolytic anemia in which there is a change in the red blood cell membrane, which results in its destruction and presence of red blood cells in urine.

How to identify hemoglobin in urine 

Hemoglobin in the urine is positive when, after the chemical test with reagent strips, signs, traces or crosses appear on the strip and the result is negative when there are no changes.

Generally, the more traces or crosses are present on the strip, the greater the amount of blood in the urine. However, it is always necessary to read the instructions on the packaging of the reagent strips, since the analysis of the results depends on the laboratory of the reagent strips.

In addition to the strip test, a microscopic examination can also be done through sediment microscopy, which detects the amount of blood present. In this case, it is considered normal to have less than 3 to 5 red cells per field or less than 10,000 cells per ml. 

Symptoms of hemoglobin in urine

Hemoglobinuria does not always cause symptoms, however, there may be changes in urine, such as it becoming red and transparent. In severe cases, due to the loss of large amounts of hemoglobin, which are responsible for transporting oxygen and nutrients, can cause fatigue, pallor and even anemia.

How to treat hemoglobin in urine

The treatment for hemoglobin in urine depends on the cause and should be guided by a urologist. During treatment it may be necessary to use medication such as antibiotics, antianemic drugs or bladder catheter application.

Bibliography >

  • MUNDT, Lilian A.; SHANAHAN, Kristy. Exame de urina e de fluidos corporais de Graff. 2.ed. Porto Alegre: Artmed, 2012. 25-55.
  • LIU, Jen-Jane; JONES, Stephen; RAO, Pravin K. Urinalysis in the Evaluation of Hematuria. JAMA. Vol.315(24). 2726-2727, 2016
  • STRASINGER, Susan K.; DI LORENZO, Marjorie S. Urianalysis and body fluids. 5 ed. Estados Unidos: E. A Davis Company, 2008. 66.
  • UNIVERSITY OF CALIFORNIA SAN FRANCISCO. Hemoglobinuria. Available on: <https://www.ucsfbenioffchildrens.org/tests/003363.html>. Access in 15 Jul 2019
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