workup for persistent trace 'blood' on dipstick, but less than 3 rbc/high powered field

JustPlainBill

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So of course workup for over 3 or 5 RBC per highpowered field is look for obvious reasons of hematuria on hx/pe/ix (i.e. culture), treat, then repeat, and if persistent, on to u/s, +/- cytology +/- referral to uro.

but what of the folks who have trace on dipstick, but neg urinalysis? and it persists? how do i work myoglobinuria/hemoglobinuria into the workup and at what point do i refer and to whom?

anybody have a good resource to look at this one? i've looked at aafp for asymptomatic hematuria, but not getting a sense of how to work up the +ve trace dip, persistent, with clear urinalysis.
You might try a one month membership to UpToDate for around $47 --- or grab a recent copy of the Washington Manual -- or pick up the phone and call your friendly neighborhood urologist and discuss it with them over a beer -- most specialists actually like helping out with "here's what you need to do to for a workup so that when you do send us something, all the information is there" which helps you weed through the stuff that rightfully a PCP should handle ---
 
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oldanddone

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hmm. ok pulling out my washington manual. but aafp really does have good articles, and geared towards fp, whereas washington manual i find and also utd for that matter has the full scope that perhaps is beyond. maybe i'll just use the old 'repeat and hope it's gone' as the first step again. additionally, i was wondering whether these kinds of questions were appropriate for sdn, and i believe your response might indicate that perhaps they aren't. so will delete.
 
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JustPlainBill

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hmm. ok pulling out my washington manual. but aafp really does have good articles, and geared towards fp, whereas washington manual i find and also utd for that matter has the full scope that perhaps is beyond. maybe i'll just use the old 'repeat and hope it's gone' as the first step again. additionally, i was wondering whether these kinds of questions were appropriate for sdn, and i believe your response might indicate that perhaps they aren't. so will delete.
Don't know if they're appropriate or not -- I'd PM BlueDog -- or whoever the moderator of the forum is -- to be sure -- I do know that seeking medical advice on the boards is verboten ---
 

smq123

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Seeking medical advice about your own health on SDN is prohibited, but asking clinical questions about medical practice is fine.
 
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Blue Dog

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Seeking medical advice about your own health on SDN is prohibited, but asking clinical questions about medical practice is fine.
Correct.

I usually just refer to urology. I may or may not order a RUS, urine culture and urine cytology beforehand. They're typically going to need a cystoscopy anyway, so I don't see much point in doing a partial workup.
 

Doctor4Life1769

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If there is significant smoking hx and it does not appear to be a kidney stone related issue, then I send for microscopy and if abnormal then I refer to urology. I screen for smoking hx, previous cancer, medications, trauma, and kidney stones.
 
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Crayola227

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I may be wrong, but if pos dipstick but NO rbcs you can check a CK and this would point you to myoglobinuria, as well as the history maybe.

If you keep seeing blood on dipstick and microscopy, even if it you think stones if it's not from a run of the mill UTI it goes to straight to uro.

It seems like much ado about nothing, but as I understand it even microscopic hematuria (you see rbcs) doesnt get shrugged off.

Could be wrong, not my thing.

And don't delete your post just cuz someone was snarky about reading UTD. Better to ask ither docs than just rely on the computer.
 

oldanddone

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The workup for CA often starts with a guideline for 3 or more rbc on high powered field but grey zone of dip pos but less than 3 I have a few people in this boat. Will send and ask for feedback ie hopefully receive back in a consult letter. The cytology some guidelines say to skip and just refer. May do u/s while waiting for consult. Uro is quite jammed in this area. If hx suggests may do the myo hemo lactate path. Ask for a urinalysis proper as trace blood by protocol won't get a sediment analysis. Thanks for the responses

Edit: may do cytology since Uro so jammed in case something prompts quicker if needed
 
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