{"id":2161,"date":"2021-01-15T08:00:00","date_gmt":"2021-01-15T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=2161"},"modified":"2026-08-27T20:49:33","modified_gmt":"2026-08-27T13:49:33","slug":"%e0%a6%ae%e0%a6%be%e0%a6%87%e0%a6%95%e0%a7%8d%e0%a6%b0%e0%a7%8b%e0%a6%b8%e0%a7%8d%e0%a6%95%e0%a7%8b%e0%a6%aa%e0%a6%bf%e0%a6%95-%e0%a6%b9%e0%a7%87%e0%a6%ae%e0%a6%be%e0%a6%9f%e0%a7%81%e0%a6%b0%e0%a6%bf","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/bn\/2021\/01\/15\/microscopic-hematuria\/","title":{"rendered":"\u09aa\u09cd\u09b0\u09b8\u09cd\u09b0\u09be\u09ac\u09c7 \u0985\u09a6\u09c3\u09b6\u09cd\u09af \u09b0\u0995\u09cd\u09a4: \u09ae\u09be\u0987\u0995\u09cd\u09b0\u09cb\u09b8\u09cd\u0995\u09cb\u09aa\u09bf\u0995 \u09b9\u09c7\u09ae\u09be\u099f\u09c1\u09b0\u09bf\u09af\u09bc\u09be\u09b0 \u0985\u09b0\u09cd\u09a5 \u0995\u09c0"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-e269d6e6 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/bn\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=12%2C12&amp;ssl=1 12w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=600%2C600&amp;ssl=1 600w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=400%2C400&amp;ssl=1 400w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=200%2C200&amp;ssl=1 200w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:75%\">\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/drsoaraweeurology.com\/\">Soarawee Weerasopone, Urologist<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok hospital Headquarter, Bangkok<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"tel:0880221445\">Samitivej Sriracha hospital, Chonburi \u2014 088-022-1445<\/a><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link 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1.246.262.353.175.622.443.806.804.044.083.083.157.117.222.034.066.069.144.105.235.022.054.011.099-.034.135l-.66.292c-.045.027-.082.013-.112-.045a4.043 4.043 0 0 0-.155-.27 1.247 1.247 0 0 0-.49-.495c-.225-.131-.522-.196-.892-.196-.402 0-.726.064-.972.193-.247.13-.422.302-.527.518-.027.045-.054.099-.082.16a1.39 1.39 0 0 0-.067.197 2.46 2.46 0 0 0-.05.282 5.51 5.51 0 0 0-.033.43c-.008.17-.013.376-.013.617 0 .242.005.448.013.618.008.17.02.314.034.43.013.117.03.21.05.282.02.072.042.137.066.197.105.216.28.39.527.518.246.13.57.193.972.193.4 0 .714-.07.94-.21.227-.14.394-.346.503-.617a2.43 2.43 0 0 0 .104-.395c.018-.123.027-.282.027-.477V13.2H2.34c-.04 0-.06-.02-.06-.062v-.5c0-.04.02-.062.06-.062h1.812c.04 0 .062.02.062.06v.5c0 .156-.005.296-.014.422a4.71 4.71 0 0 1-.04.342 1.732 1.732 0 0 1-.064.262c-.13.523-.402.913-.815 1.17-.413.255-.95.382-1.61.382z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/orcid.org\/0009-0004-8387-3559\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"ORCID iD\"\n     aria-label=\"View ORCID Profile\"\n     style=\"text-decoration: none; color: #A6CE39; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M12 0C5.372 0 0 5.372 0 12s5.372 12 12 12 12-5.372 12-12S18.628 0 12 0zM7.369 4.378c.525 0 .947.431.947.947 0 .525-.422.947-.947.947-.525 0-.946-.422-.946-.947 0-.525.421-.947.946-.947zm-.722 3.038h1.444v10.041H6.647V7.416zm3.562 0h3.9c3.712 0 5.344 2.653 5.344 5.025 0 2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"has-drop-cap wp-block-paragraph\">A urine test is part of almost every health-check package, which means a great many people are told they have red blood cells in their urine having had no symptoms and no reason to think anything was wrong. Most of the time the explanation is harmless. The purpose of the assessment is to be sure of that rather than to assume it.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">A correction to the reassurance this page used to give<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The earlier version of this article said, in effect, <em>don&#8217;t worry \u2014 if it were a real problem you would see the blood with your own eyes.<\/em> <strong>That is not true, and it has been removed.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bladder cancer frequently produces bleeding that is only ever detectable under a microscope, particularly in its early stages. The reassurance was well meant and it is exactly the sentence that persuades someone to skip the follow-up appointment. The accurate version: <strong>most causes are benign, a minority are not, and which is which cannot be judged from how the urine looks.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img decoding=\"async\" width=\"1200\" height=\"695\" data-attachment-id=\"2169\" data-permalink=\"https:\/\/drsoaraweeurology.com\/bn\/2021\/01\/15\/microscopic-hematuria\/medical-check-up-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Medical-check-up-2.jpg?fit=1200%2C695&amp;ssl=1\" data-orig-size=\"1200,695\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;adihb&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1567020241&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Urine examination test is a simple investigation which always included in Health check up program.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Urine examination test is a simple investigation which always included in Health check up program.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Medical-check-up-2.jpg?fit=800%2C463&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Medical-check-up-2.jpg?resize=800%2C463&amp;ssl=1\" alt=\"Urine sample being tested as part of a routine health check package\" class=\"wp-image-2169\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Medical-check-up-2.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Medical-check-up-2.jpg?resize=300%2C174&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Medical-check-up-2.jpg?resize=1024%2C593&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Medical-check-up-2.jpg?resize=768%2C445&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Medical-check-up-2.jpg?resize=16%2C9&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Most people meet this finding through a health-check package rather than through symptoms.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What counts as microscopic haematuria<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Three or more red blood cells per high-power field on a properly collected specimen examined under the microscope.<\/strong> Two points about that definition matter and were stated differently in the earlier version.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>A dipstick result is not enough.<\/strong> A stick that reads positive for blood must be confirmed by looking down a microscope, because several things turn a dipstick positive without any red cells being present.<\/li>\n\n\n\n<li><strong>Repeat testing is not required to make the diagnosis.<\/strong> The earlier version described needing two consecutive tests over at least seven days; current guidance defines it on a single adequate specimen. A repeat is useful for a different purpose \u2014 excluding contamination.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Where the blood comes from<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Contamination during collection<\/strong> \u2014 the commonest explanation of all, including menstruation and a poorly taken sample.<\/li>\n\n\n\n<li><strong>Kidney<\/strong> \u2014 <a href=\"https:\/\/drsoaraweeurology.com\/2020\/11\/06\/why-kidney-stone-happens\/\">stones<\/a>, a mass, infection, and kidney diseases that are treated by physicians rather than surgeons.<\/li>\n\n\n\n<li><strong>Ureter<\/strong> \u2014 stones, or a tumour of the lining.<\/li>\n\n\n\n<li><strong>Bladder<\/strong> \u2014 stones, <a href=\"https:\/\/drsoaraweeurology.com\/2020\/08\/21\/bladder-cancer-so-do-i\/\">tumour<\/a>, <a href=\"https:\/\/drsoaraweeurology.com\/2020\/07\/11\/bladder-infection-acute-cystitis\/\">infection<\/a>.<\/li>\n\n\n\n<li><strong>Prostate<\/strong> \u2014 <a href=\"https:\/\/drsoaraweeurology.com\/2020\/08\/28\/benign-prostate-bph\/\">benign enlargement<\/a>, <a href=\"https:\/\/drsoaraweeurology.com\/2020\/07\/24\/what-is-acute-prostate-infection\/\">infection<\/a>, cancer.<\/li>\n\n\n\n<li><strong>Urethra<\/strong> \u2014 stones, infection, or <a href=\"https:\/\/drsoaraweeurology.com\/2021\/05\/14\/urethral-stricture-narrow-urethra\/\">narrowing<\/a>.<\/li>\n\n\n\n<li><strong>Vigorous exercise<\/strong>, which can cause transient haematuria that settles on repeat testing.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">One misconception worth naming: <strong>taking a blood thinner does not explain blood in the urine.<\/strong> Anticoagulation may make an existing source bleed more visibly, but it does not create one, and a man on warfarin or a newer anticoagulant with haematuria needs the same assessment as anyone else. Attributing it to the tablets is a recognised route to a delayed diagnosis.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How far the investigation goes depends on your risk<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The earlier version said CT with contrast is the definitive test and is what answers the question. <strong>That inverts the guideline it cited, and it has been corrected.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The central change in the 2020 American Urological Association guidance was precisely to <strong>stop sending everyone for CT<\/strong>. Instead, patients are placed in a low, intermediate or high risk group, and the investigation is matched to it \u2014 because CT carries a substantial radiation dose and a contrast load, and most people with a few red cells in the urine do not need one.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What determines the group:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Age<\/strong>, and <strong>being male<\/strong>.<\/li>\n\n\n\n<li><strong>Smoking history<\/strong> \u2014 the single strongest modifiable risk factor for urothelial cancer, and the one most often not asked about.<\/li>\n\n\n\n<li><strong>How many red cells<\/strong>, and whether it has been found repeatedly.<\/li>\n\n\n\n<li><strong>Any previous episode of visible blood in the urine.<\/strong><\/li>\n\n\n\n<li><strong>Occupational exposure<\/strong> to dyes, rubber, leather or industrial chemicals, sometimes decades earlier.<\/li>\n\n\n\n<li><strong>Previous pelvic radiotherapy, chemotherapy with cyclophosphamide, a long-term catheter, or chronic irritative urinary symptoms.<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Lower risk<\/strong> may reasonably mean a repeat urine test, or an ultrasound, rather than a CT and a telescope. <strong>Higher risk<\/strong> means the full assessment \u2014 imaging of the kidneys and ureters, and inspection of the bladder.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img decoding=\"async\" width=\"1200\" height=\"801\" data-attachment-id=\"2168\" data-permalink=\"https:\/\/drsoaraweeurology.com\/bn\/2021\/01\/15\/microscopic-hematuria\/doctor-checking-x-ray-results\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Microscopic-CT-scan.jpg?fit=1200%2C801&amp;ssl=1\" data-orig-size=\"1200,801\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;Doctor checking x-ray results&quot;,&quot;created_timestamp&quot;:&quot;1498572884&quot;,&quot;copyright&quot;:&quot;Rawpixel Ltd.&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;200&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;Doctor checking x-ray results&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"In case we need the definite investigation on Microscopic hematuria, CT contrasted study is recommended.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;In case we need the definite investigation on Microscopic hematuria, CT contrasted study is recommended.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Microscopic-CT-scan.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Microscopic-CT-scan.jpg?resize=800%2C534&amp;ssl=1\" alt=\"CT scanner used for imaging the kidneys and ureters in higher-risk haematuria\" class=\"wp-image-2168\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Microscopic-CT-scan.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Microscopic-CT-scan.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Microscopic-CT-scan.jpg?resize=1024%2C684&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Microscopic-CT-scan.jpg?resize=768%2C513&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/01\/Microscopic-CT-scan.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">CT is for the higher-risk groups \u2014 it is no longer the automatic first step for everyone.<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">The part that was missing entirely: looking in the bladder<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Cystoscopy did not appear anywhere in the earlier version, and no scan replaces it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>CT does not reliably show a flat tumour on the bladder lining.<\/strong> Carcinoma in situ can be invisible on imaging and obvious through a telescope, so for anyone in the intermediate or high risk group the assessment is imaging <em>and<\/em> <a href=\"https:\/\/drsoaraweeurology.com\/2023\/12\/09\/flexible-cystoscopy\/\">a flexible cystoscopy<\/a> \u2014 a few minutes, awake, in a clinic room. A normal CT is not, by itself, an all-clear.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When it is the kidney rather than the plumbing<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Some blood in the urine comes from the filtering tissue of the kidney rather than from anywhere a urologist can see. The clues are <strong>protein in the urine, abnormal-looking red cells or casts, a raised creatinine, or high blood pressure<\/strong> \u2014 and that combination belongs with a kidney physician, in parallel with the urological assessment rather than after it.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">If everything is normal<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most assessments find nothing, and that is a genuine result rather than a failure to look hard enough. The urine is then rechecked, and <strong>follow-up can be stopped once repeat testing has come back clear<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What matters afterwards: if <strong>visible<\/strong> blood ever appears, that is a new event and needs assessing again regardless of how reassuring the previous work-up was.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Symptoms that need attention rather than a routine appointment<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In an emergency in Thailand, call <strong>1669<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Blood you can see<\/strong>, with or without clots \u2014 this is a different and more urgent problem than microscopic haematuria, and painless visible bleeding is more concerning rather than less.<\/li>\n\n\n\n<li><strong>Clots blocking the flow, or inability to pass urine.<\/strong><\/li>\n\n\n\n<li><strong>Fever with flank pain.<\/strong><\/li>\n\n\n\n<li><strong>Unexplained weight loss, or new bone pain<\/strong>, alongside blood in the urine.<\/li>\n\n\n\n<li>Severe flank pain with vomiting, which suggests a stone.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions About Microscopic Haematuria<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Is it dangerous?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Usually not \u2014 contamination and benign causes account for most of it. But it cannot be dismissed on appearance, because early bladder cancer often bleeds only microscopically. An earlier version of this article suggested a real problem would be visible to the naked eye; that was wrong and has been removed.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Do I need a CT scan?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Not necessarily. Current guidance stratifies patients into low, intermediate and high risk and matches the investigation to the group \u2014 a repeat urine test or an ultrasound may be appropriate at lower risk, reserving CT for those who need it, since it carries a significant radiation and contrast load. Age, sex, smoking history, the amount of blood, any previous visible bleeding and certain exposures determine the group.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">My CT was normal. Is that the all-clear?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Not on its own for anyone at intermediate or high risk. CT does not reliably show a flat tumour on the bladder lining, so the assessment includes looking inside the bladder with a flexible telescope \u2014 a few minutes, awake, in a clinic room.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">I take a blood thinner. Doesn&#8217;t that explain it?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">No. Anticoagulation can make an existing source bleed more, but it does not create one, and haematuria in someone taking a blood thinner is assessed exactly as it would be otherwise. Assuming the tablets are responsible is a recognised route to a delayed diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When can follow-up stop?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Once the assessment has found no cause and repeat urine testing has come back clear. If visible blood ever appears afterwards, that is a new event needing assessment regardless of the earlier result.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Arranging a consultation<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Dr. Soarawee Weerasopone sees patients at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital in Chonburi on <a href=\"tel:0880221445\">088-022-1445<\/a>. Bring the actual urinalysis report rather than a summary, and be ready to say whether you have ever smoked and for how long \u2014 that question changes how far the assessment goes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital, not by this website.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters, and is intended for education only. It is not medical advice, diagnosis or a prescription for any individual, and no advice, diagnosis or prescription is given through personal messaging channels or social media. Dr. Soarawee operates no public social media account; any account offering private consultation in his name is fraudulent. In an emergency in Thailand, call <strong>1669<\/strong>.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/01\/15\/microscopic-hematuria\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/01\/15\/microscopic-hematuria\/\",\n      \"name\": \"Blood in the Urine You Cannot See: What Microscopic Haematuria Means\",\n      \"description\": \"Microscopic haematuria is evaluated by risk stratification rather than by universal CT, and cystoscopy is required at intermediate and high risk because imaging does not reliably show flat bladder tumours.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2021-01-15\",\n      \"dateModified\": \"2026-08-27\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/01\/15\/microscopic-hematuria\/#microhaematuria\" },\n      \"audience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"disambiguatingDescription\": \"Three corrections were made. The article reassured readers that a serious cause would produce visible blood; early bladder cancer frequently bleeds only microscopically, and that statement has been removed. It described contrast CT as the definitive investigation for all patients, which inverts the 2020 AUA guidance it cited: that guidance introduced risk stratification into low, intermediate and high risk groups specifically to avoid universal CT, with repeat urinalysis or renal ultrasound appropriate at lower risk. Cystoscopy was absent from the article entirely, although CT does not reliably demonstrate flat urothelial lesions and a normal scan is not an all-clear at intermediate or high risk. The definition has been updated: three or more red cells per high-power field on a single properly collected microscopic specimen, with dipstick positivity requiring microscopic confirmation and repeat testing not required to establish the diagnosis. 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It cannot be dismissed on appearance, however, because early bladder cancer often bleeds only microscopically.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Do I need a CT scan for microscopic haematuria?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Not necessarily. Current guidance stratifies patients into low, intermediate and high risk and matches investigation to the group, with repeat urinalysis or ultrasound appropriate at lower risk and CT reserved for those who need it.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"My CT was normal. Is that an all-clear?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Not on its own at intermediate or high risk. CT does not reliably show a flat tumour on the bladder lining, so assessment includes flexible cystoscopy.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"I take a blood thinner. Does that explain blood in my urine?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"No. Anticoagulation may make an existing source bleed more but does not create one, and haematuria is assessed exactly as it would be otherwise. Attributing it to the medication is a recognised route to delayed diagnosis.\" }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>\u09b8\u09cd\u09ac\u09be\u09b8\u09cd\u09a5\u09cd\u09af \u09aa\u09b0\u09c0\u0995\u09cd\u09b7\u09be\u09b0 \u09aa\u09cd\u09b0\u09b8\u09cd\u09b0\u09be\u09ac \u09aa\u09b0\u09c0\u0995\u09cd\u09b7\u09be\u09af\u09bc \u09b2\u09cb\u09b9\u09bf\u09a4 \u09b0\u0995\u09cd\u09a4\u0995\u09a3\u09bf\u0995\u09be \u09aa\u09be\u0993\u09af\u09bc\u09be \u0997\u09c7\u099b\u09c7\u0964 \u09ac\u09c7\u09b6\u09bf\u09b0\u09ad\u09be\u0997 \u0995\u09be\u09b0\u09a3\u0987 \u09a8\u09bf\u09b0\u09c0\u09b9 \u2014 \u0995\u09bf\u09a8\u09cd\u09a4\u09c1 \u0995\u09cb\u09a8\u09cb \u0986\u09b8\u09b2 \u09b8\u09ae\u09b8\u09cd\u09af\u09be \u09a6\u09c3\u09b6\u09cd\u09af\u09ae\u09be\u09a8 \u09b9\u09ac\u09c7, \u098f\u0987 \u0986\u09b6\u09cd\u09ac\u09be\u09b8\u099f\u09bf \u09ad\u09c1\u09b2, \u098f\u09ac\u0982 \u09a4\u09a6\u09a8\u09cd\u09a4 \u0995\u09a4\u09a6\u09c2\u09b0 \u0997\u09a1\u09bc\u09be\u09ac\u09c7 \u09a4\u09be \u098f\u0995\u099f\u09bf\u09ae\u09be\u09a4\u09cd\u09b0 \u09b8\u09be\u09a7\u09be\u09b0\u09a3 \u09b8\u09cd\u0995\u09cd\u09af\u09be\u09a8\u09c7\u09b0 \u0993\u09aa\u09b0 \u09a8\u09bf\u09b0\u09cd\u09ad\u09b0 \u09a8\u09be \u0995\u09b0\u09c7, \u09ac\u09b0\u0982 \u0986\u09aa\u09a8\u09be\u09b0 \u099d\u09c1\u0981\u0995\u09bf\u09b0 \u09ae\u09be\u09a4\u09cd\u09b0\u09be\u09b0 \u0993\u09aa\u09b0 \u09a8\u09bf\u09b0\u09cd\u09ad\u09b0 \u0995\u09b0\u09c7\u0964.<\/p>","protected":false},"author":185281453,"featured_media":10067,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Microscopic haematuria found at a health check: what causes it, why risk stratification decides between ultrasound and CT, why cystoscopy matters, and when follow-up can stop.","jetpack_seo_html_title":"Microscopic Haematuria: What It Means & What Is Done | Dr. Soarawee","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1],"tags":[1424,1425,1423],"class_list":["post-2161","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kidney-stone","tag-bleeding-in-urine","tag-hematuria","tag-microscopic-hematuria"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-yR","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Microscopic-Hematuria.jpg?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/posts\/2161","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/comments?post=2161"}],"version-history":[{"count":31,"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/posts\/2161\/revisions"}],"predecessor-version":[{"id":11751,"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/posts\/2161\/revisions\/11751"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/media\/10067"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/media?parent=2161"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/categories?post=2161"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/bn\/wp-json\/wp\/v2\/tags?post=2161"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}