Hematuria in Leukemia and Lymphoma

What Can Cause Blood in the Urine?

Hematuria: presence of red blood cells in urinary system, drawing : News Photo CompAdd to Board Hematuria: presence of red blood cells in urinary system, drawing. Credit: Dea Picture Library / Contributor / Getty Images

Hematuria means there is blood in the urine. Normally there shouldn't be any blood in the urine, so it is a finding that will prompt your doctor to find and treat the source.

There are two categories of hematuria. If you can see blood in the urine, it is called gross hematuria, macroscopic hematuria or frank blood in the urine. This is always a cause for concern and should be reported to your doctor. If blood is only detected with a urine test but not visible, it is microscopic hematuria. Both types of hematuria have a variety of causes.

Symptoms of Hematuria

You will suspect hematuria when you see that your urine has streaks of blood or blood clots. But you may also notice that your urine has changed color and is red, pink, or a cola brown color. It only takes a small amount of blood to make these color changes. Often you don't have pain, but you may have bladder or urethra pain or other symptoms of a urinary tract infection, which is a common cause of hematuria.

When Should You Contact Your Doctor?

You should always contact your healthcare team if you think that you have blood in your urine. While some causes are less serious than others, it is a symptom that needs follow-up.

Causes of Hematuria in Leukemia and Lymphoma

In patients with leukemia or lymphoma, there are many possible causes of hematuria:

  • Urinary tract infections from bacteria or viruses. You may have an infection in the kidney, bladder, urethra or prostate. This can be one a result of immune system suppression caused by treatment. Your body can't clear out bacteria as well. 
  • Low platelet counts (thrombocytopenia) due to your condition or as a result of treatment. Platelets plug any microscopic bleeding sites in the body, and when they are low they can't do their job, and some blood can escape into the urine.
  • Irritation of bladder lining from chemotherapy or radiation therapy. Inflammation causes seepage of blood cells into the urine.
  • Certain medications, including aspirin, which reduces the ability of platelets to plug holes in the blood vessels, antibiotics, and blood thinners.
  • Sexual activity or intense exercise
  • Enlarged prostate
  • Urinary stones
  • Cancer of the kidney or bladder
  • Menstruation, vaginal bleeding or hemorrhoids can contaminate the urine sample with blood cells. This would be a false positive result as the blood is not actually in the urine.

    How Hematuria is Detected

    Hematuria is diagnosed using a urinalysis, in which you void into a sterile cup. If you can't urinate, you may have the urine collected via a catheter.

    A simple chemical dipstick is used to screen for any problems, and it includes an indicator for the presence of blood. The sample may be centrifuged and checked under the microscope, looking for red and white blood cells, bacteria and crystals. You will see blood reported on the lab results, and if the microscopic examination was done, you would see RBC reported. Normally these are negative or "none seen."

    If any blood is detected, your doctor may order further tests such as a urine culture, or draw blood for a complete blood count. You may have a repeat urinalysis to see if the result is repeated before your doctor looks into it further. One thing that can cause a false positive or a false negative with the dipstick is vitamin C. Or, your sample may have been contaminated with blood from menstruation or hemorrhoids.

    Depending on your physical exam and history, a finding of hematuria may lead to a biopsy, cystoscopy or kidney imaging tests.

    Treatment of Hematuria

    How hematuria is treated depends on what is causing it. Discuss this with your doctor.

    Pronunciation: Heem-a-tur-ee-a

    Alternate Spellings: Haematuria

    View Article Sources
    • Hematuria (Blood in the Urine) National Institute of Diabetes and Digestive and Kidney Diseases, April, 2012.
    • Pham A, Steinberg A, Kwok B, et al. Precursor T-Cell acute lymphoblastic leukemia/lymphoma with rare presentation in the urinary bladder. Hematology Reports. 2011;3(2):e18.
    • Urinalysis, LabTestsOnline, American Association for Clinical Chemistry, Nov. 4, 2015.