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Hemoglobinuria: what is it and 9 main causes

Hemoglobinuria is the scientific term used to describe the presence of hemoglobin in urine, which occurs when red blood cells are destroyed and one of its constituents, hemoglobin, is eliminated by the urine, giving it a reddish and transparent color.

However, the presence of hemoglobin in urine doesn't always cause symptoms and, therefore, most times it can only be detected after a urine analysis.

Hemoglobinuria can occur in children, adults, and even pregnant women due to kidney infections, kidney stones, or serious kidney diseases such as pyelonephritis or cancer. Regardless, it is always important that a urologist assess each case to identify the cause and prescribe the best type of treatment.

Hemoglobinuria: what is it and 9 main causes

Main causes of hemoglobinuria

No hemoglobin should be found in the urine in a normal urine examination. However, hemoglobin can occur because of some situations, such as:

  1. Kidney problems, such as acute nephritis or pyelonephritis;
  2. Severe burns;
  3. Kidney cancer;
  4. Malaria;
  5. Transfusion reaction; 
  6. Urinary tract tuberculosis; 
  7. Sickle cell anemia; 
  8. Strenuous practice of physical activity;
  9. Hemolytic–uremic syndrome.

Additionally, the presence of hemoglobin in the urine may be due to excessive cold or paroxysmal nocturnal hemoglobinuria, a rare type of hemolytic anemia in which there is an alteration in the membrane of red blood cells, resulting in its destruction and the presence of red blood cells in the urine.

How to identify

The presence of hemoglobin in the urine is positive when, after a chemical test with a reagent strip, signs, dashes or crosses appear on the strip, and negative when there are no changes.

Generally, the more dashes or crosses present on the strip, the greater the amount of blood in the urine. However, it’s always important to read the instructions on the reagent strip packaging, as the analysis of the results depends on the reagent strip laboratory.

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

Main signs and symptoms

Hemoglobinuria doesn't always cause symptoms, however, there may be changes to the urine, such as becoming red and transparent. In severe cases, due to the loss of a large amount of hemoglobin, which is responsible for transporting oxygen and nutrients, people can feel easily tired, with fatigue and pallor, and even suffer from anemia.

How to treat hemoglobin in urine

Treatment for hemoglobin in the urine depends on the cause and should be guided by a urologist. During treatment, drugs such as antibiotics, antianemics or the application of a bladder catheter may be necessary.

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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