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Asymptomatic Microscopic Hematuria

Asymptomatic microscopic hematuria (AMH) is a common problem that can occasionally be a marker of severe disease such as urinary tract cancer. AMH is defined as 3 or more red blood cells per high-powered field on urine microscopy. In patients who have reasons for microscopic hematuria such as menstruation, urinary tract infection or recent instrumentation, testing should be repeated after these conditions have resolved. Most guidelines recommend that AMH should be based on 2 of 3 positive microscopic urinalyses to reduce the rate of false positive results. Diagnosis should not be based on urine dipstick analysis, which has a higher false positive rate.

In one large study of more than 20,000 asymptomatic adults with no history of urologic disease, AMH was found in 598 (3%) of cases using urine dipstick screening. Only 3 of these patients (0.5%) developed urologic cancer during the following 3 years. Two of cancers were prostate and one was bladder.

No professional medical organization recommends screening asymptomatic women or men with urine tests for detection of urinary tract cancer. The US Preventive Services Task Force (USPSTF) recommends against screening.


Subak LL & Grady D. Asymptomatic microscopic hematuria – rethinking the diagnostic algorithm. JAMA June 2017;177:808-09.

Halpern JA, Chughtai B, Ghomrawi H. Cost effectiveness of common diagnostic approaches for evaluation of asymptomatic microscopic hematuria. JAMA, published on line April 17, 2017.

Hiatt RA & Ordonez JD. Dipstick urinalysis screening, asymptomatic microhematuria and subsequent urological cancers in a population based sample. Cancer Epidemiol Biomarkers Prev 1994;3:439-443.

Moyer VA. US Preventive Services Task Force. Screening for bladder cancer. Ann Intern Med 2011;155:246-51.

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