The difference between gross hematuria and microscopic hematuria is pretty straightforward: gross hematuria is defined as any blood in the urine observed by the naked eye, while microscopic hematuria is blood found using a microscope. So if a patient says they saw blood in their urine, it is gross hematuria. If no blood is seen by the naked eye in a urine sample and blood cells are found during urine cytology, then it is microscopic.