Interpreting MSU results.
Thread Starter
Interpreting MSU results.
Anyone have an "idiot's" guide, in particular when (what level) to investigate the prescence of red blood cells on microscopy ? (Reported in numbers of rbc's x10 to the power of 3 per ml).
Cheers, ginge.
Cheers, ginge.
Join Date: Aug 2005
Location: E.Wash State
Posts: 0
Likes: 0
Received 0 Likes
on
0 Posts
Male, or female?
Actually, googling "microscopic hematuria" brings up an American Urological Assn guide, a Mayo Clinic guide, and a Cleveland Clinic guide. And also a Canadian algorithm. Looks like they are pretty similar except in the number of samples required, and that there are lots of false positives.
Interestingly, over here, the finding is usually reported as "rbc's per high power field", and can be on either an unspun or spun specimen.
Actually, googling "microscopic hematuria" brings up an American Urological Assn guide, a Mayo Clinic guide, and a Cleveland Clinic guide. And also a Canadian algorithm. Looks like they are pretty similar except in the number of samples required, and that there are lots of false positives.
Interestingly, over here, the finding is usually reported as "rbc's per high power field", and can be on either an unspun or spun specimen.
Last edited by obgraham; 16th Oct 2012 at 03:49.
Join Date: Jul 2003
Location: UK
Posts: 115
Likes: 0
Received 0 Likes
on
0 Posts
Our local guidelines (NHS in Scotland) suggest three separate confirmed episodes of microscopic haematuria on either dipstick or msu; with menstrual loss, infection, prostatism, or calculus ruled out/not expected.
Join Date: Jan 2005
Location: UK
Posts: 138
Likes: 0
Received 0 Likes
on
0 Posts
CAA have a guideline..
see http://www.caa.co.uk/docs/2499/Abnor...lysis%20FC.pdf
In an earlier life as a GP I took anything above 20 rbc/millionth of a litre as significant, but the normal values seem to vary from lab to lab.
1 plus on the urine dipstick I use is, according to the chart, equivent to >10 rbc /millionth of a litre. So it would be logical to take anything above 10 as eqivalent to a positive dipstick for blood.
It is a bit tick box I know. (and how you convert rbc/millionth of a litre to rbc/HPF (high power field), has always been a mystery to me.
see http://www.caa.co.uk/docs/2499/Abnor...lysis%20FC.pdf
In an earlier life as a GP I took anything above 20 rbc/millionth of a litre as significant, but the normal values seem to vary from lab to lab.
1 plus on the urine dipstick I use is, according to the chart, equivent to >10 rbc /millionth of a litre. So it would be logical to take anything above 10 as eqivalent to a positive dipstick for blood.
It is a bit tick box I know. (and how you convert rbc/millionth of a litre to rbc/HPF (high power field), has always been a mystery to me.
Join Date: Aug 2005
Location: E.Wash State
Posts: 0
Likes: 0
Received 0 Likes
on
0 Posts
and how you convert rbc/millionth of a litre to rbc/HPF (high power field), has always been a mystery to me.
Thread Starter
Thanks for the info, I spoke to our man at the lab, who suggested that the readings from his automated machine have to be read in context of what the machine is designed for (detecting UTI's).
He reckoned that the (?British) Urological Society say two readings of 1+ on a dipstick is used to define microscopic haematuria. I think the referral pathway then depends on whether the blood U+E's are deranged.
Watch this space, am on the job
He reckoned that the (?British) Urological Society say two readings of 1+ on a dipstick is used to define microscopic haematuria. I think the referral pathway then depends on whether the blood U+E's are deranged.
Watch this space, am on the job
Join Date: Nov 2012
Location: South Coast
Age: 37
Posts: 15
Likes: 0
Received 0 Likes
on
0 Posts
unless you've had a stone or recent UTI I strongly recommened letting your GP know. Microscopic haematuria could mean other things - might need a camera look inside your bladder but ask for a medical opinion.
Join Date: Mar 2007
Location: sydney
Age: 64
Posts: 82
Likes: 0
Received 0 Likes
on
0 Posts
So as a urologist, my brief guide would be this.
The dipstick does throw up a number of false positive results, and ,as a chemical reagent test, is inferior to the direct urine lab microscopy (" MSU MC & S).
On most labs, < 10 RBC would be normal. An example is pasted below :
Urine
pH 7
Protein Nil
Glucose Nil
Blood Nil
Ketones Nil
Bilirubin Nil
Specific gravity 1.016 (1.005 - 1.030)
Microscopy
Leucocytes 3 x10^6/L ( <10 )
RBC Erythrocytes 3 x10^6/L ( <10 )
Epithelial cells 0 x10^6/L
Casts NIL
Culture No growth
Thus I rely on that, and urine cytology and ultrasound, to then decide who needs cystoscopy.
(Take also in context of AUA , EAU and BAUS guidelines).
Cheers,
Graham.
The dipstick does throw up a number of false positive results, and ,as a chemical reagent test, is inferior to the direct urine lab microscopy (" MSU MC & S).
On most labs, < 10 RBC would be normal. An example is pasted below :
Urine
pH 7
Protein Nil
Glucose Nil
Blood Nil
Ketones Nil
Bilirubin Nil
Specific gravity 1.016 (1.005 - 1.030)
Microscopy
Leucocytes 3 x10^6/L ( <10 )
RBC Erythrocytes 3 x10^6/L ( <10 )
Epithelial cells 0 x10^6/L
Casts NIL
Culture No growth
Thus I rely on that, and urine cytology and ultrasound, to then decide who needs cystoscopy.
(Take also in context of AUA , EAU and BAUS guidelines).
Cheers,
Graham.
Thread Starter
Thanks Graham, appreciate the advice, it does seem to be at odds with the Brits...
http://www.baus.org.uk/Resources/BAU..._July_2008.pdf
? Maybe because of the role of primary care in initial detection.
http://www.baus.org.uk/Resources/BAU..._July_2008.pdf
? Maybe because of the role of primary care in initial detection.
Join Date: Aug 2005
Location: E.Wash State
Posts: 0
Likes: 0
Received 0 Likes
on
0 Posts
Aussiepax:
Is that microscopy report based on a machine-read cell count, or a manual look-see by the tech?
(My standard advice is to always follow the recommendation of any doc named Graham.)
Graham 1 of 2
Is that microscopy report based on a machine-read cell count, or a manual look-see by the tech?
(My standard advice is to always follow the recommendation of any doc named Graham.)
Graham 1 of 2
Thread Starter
Is that microscopy report based on a machine-read cell count, or a manual look-see by the tech?
Here's my position, I see about 50 patient's a day, and for various reason's, I send 3 or 4 MSU's a day to the lab.
My 6 other colleagues probably do the same.
When do we refer, and when do we not ?
Join Date: Aug 2001
Location: UK
Posts: 2,410
Likes: 0
Received 0 Likes
on
0 Posts
You should have local guidelines, developed with your pathlab and urologists.
Persistent haematuria (as defined by your local clinicians and lab) in conjunction with national guidelines should be investigated.
Persistent haematuria (as defined by your local clinicians and lab) in conjunction with national guidelines should be investigated.