Asymptomatic Microscopic Hematuria (AMH
Definition: AMH is defined as the presence of 3 or more RBCs per high-power field visible in a properly collected urine specimen without evidence of infection.
-AMH is ≥ 3RBC/HPF
-Further evaluation is indicated in this patient with AMH.
-CBC, CMP, UA, UCx.
-Computed tomography urography
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Hematuria on a UA should be reported as 0 to 3 RBC/HPF, 4 to 10 RBC/HPF, 11 to 25 RBC/HPF, 26 to 50 RBC/HPF, >50 RBC/HPF, or gross hematuria.
Use this excellent article with an algorithm.
“Asymptomatic microscopic hematuria is defined by the American Urological Association (AUA) as ³3 RBCs/hpf in the absence of an obvious cause such as menstruation, infection, vigorous exercise, renal disease, trauma, a recent urologic procedure, or a viral illness. Urine microscopy is required to confirm hematuria found on a dipstick examination. This patient has risk factors for urothelial cancer, including smoking, his age, and his sex. In a patient with no obvious cause for hematuria, the AUA does NOT recommend repeating the urinalysis or treating empirically with antibiotics, as this may delay the diagnosis of cancer. In addition, assuming that benign prostatic hyperplasia (BPH) is the cause for his hematuria is inadvisable; patients with BPH usually also have risk factors for malignancy. The recommended initial workup includes renal function testing, CT urography, and cystoscopy.
Ref: Sharp VJ, Lee DK, Askeland EJ: Urinalysis: Case presentations for the primary care physician. Am Fam Physician 2014;90(8):542-547” ABFM
References
Am Fam Physician. 2013 Dec 1;88(11):747-754. Assessment of Asymptomatic Microscopic Hematuria in Adults. http://www.aafp.org/afp/2013/1201/p747.html