Hemoglobin in urine: what does it mean? Causes and signs of violation, norm

Hemoglobin in urine - what does this mean in a child?

The presence of hemoglobin in urine means that a large amount of blood enters the urine.
Red blood cells are destroyed by the acids and salts present in the urine, and hemoglobin enters the urine. The red blood cells themselves are visible under a microscope in the form of discolored rings, and are easily detected in the laboratory. Expert opinion

Kovaleva Elena Anatolyevna

Doctor-Laboratory Assistant. 14 years of experience in clinical diagnostic services.

Blood in the urine is an alarming sign that indicates kidney or urinary tract disease.

The presence of hemoglobin in the urine may indicate the development of a disease such as hemoglobinuria in the body. The disease is otherwise called hemolytic anemia. A sign of this disease is the penetration of hemoglobin into the urine.

At the same time, immediate disintegration of all blood cells occurs there. At this time, the body may develop any infectious diseases, for example, the same flu. In addition, the disease can manifest itself after severe hypothermia, various injuries, or physical exertion.

There is a toxic type of hemoglobinuria and acquired. The acquired type is called paroxysmal nocturnal hemoglobinuria (Strübing-Marchiafava disease). Having found traces of hemoglobin in urine, only a specialist should decide what this means. Perhaps he will just establish acquired hemoglobinuria in the patient.

The other type (toxic) is characterized by massive hemolysis. All signs of toxic poisoning by pesticides, toxic products, and poisonous insects are detected. Hemoglobin can also appear during march sickness, when severe pressure is felt on the feet. The rarest type of hemoglobinuria is cold hemoglobinuria.

Every mother cares about the health of her baby and, in case of any deviations, should rush to the pediatrician for help. If you notice that the color of your child’s urine has become abnormal, brownish-dark, you need to urgently get tested and identify the causes of the pathology. If hemoglobin is detected in the urine, what does this mean, consult your pediatrician.

After the first analysis, it is necessary to do a repeat study a little later. If hemoglobin is detected in the urine, the child will be sent for additional examination - ultrasound of the genitourinary system, blood test.

Prevention

There is no specific prevention of hemoglobinuria.

To prevent the development of pathology, patients are advised to lead a healthy lifestyle, avoid acute and chronic intoxication, and treat infectious diseases promptly and fully.

In addition, you should plan the amount of physical activity and avoid injuries.

Changes in a child's urine test can identify various diseases. Moreover, any deviations from the norm can cause anxiety among parents, for example, if the analysis form indicates that the baby’s urine contains hemoglobin. Can such a substance be in the urine of a healthy child, what is it a sign of and what to do if a baby’s urine analysis shows the presence of hemoglobin?

Signs of hemoglobinuria

Since hemoglobin is red in color (bright red in the oxidized state and dark red when combined with carbon dioxide), the first sign of its appearance in the urine is a change in its color. The color changes from yellow or clear to brown or dark red.

The urine that you collect for analysis will be stratified into an upper, transparent layer, and a lower, cloudy layer with a red tint.

The same reasons that cause hematuria often lead to unpleasant sensations in the kidneys and lower back. This is a dull pain, a feeling of heaviness, a pulling sensation, etc. In severe cases, acute pain and renal colic are observed (this is observed, for example, in the case of urolithiasis).

If a person has hemoglobin in his urine, what does this mean? This result indicates the penetration of blood into the urine. The etiology of the deviation may be different. The following causes of hemoglobin in urine can be distinguished:

1. This protein enters urine during bleeding in the organs of the urinary system. This can be observed with glomerulonephritis, inflammatory processes and tumors in the excretory organs. In such cases, the urine turns pinkish or reddish. The analysis reveals a large number of red blood cells. This phenomenon is called hematuria.
2. Hemoglobin can enter the urine when red blood cells are destroyed in the blood vessels. This condition is called hemolytic anemia. This is observed in cases of intoxication, pathologies of the spleen, allergic reactions, infections, injuries, burns. In these diseases, the blood plasma contains a large amount of hemoglobin. This protein then penetrates the glomeruli of the kidneys and ends up in urine. This is an extremely dangerous condition that can lead to kidney failure.
3. Hemoglobin in the urine may be observed after a blood transfusion. This indicates that the donor material was not suitable for the patient. In this case, massive destruction of red blood cells occurs in the body.
4. Positive hemoglobin in urine can be determined by an increase in the level of myoglobin, a protein found in muscles. These two compounds are very similar in structure. Therefore, myoglobin in the analysis results is often defined as hemoglobin. Increased muscle protein levels are a sign of serious muscle disease.
5. Track and field athletes sometimes experience a marching form of hemoglobinuria. This is the result of increased stress on the legs. Such a deviation is not considered a pathology. Hemoglobinuria usually disappears after eliminating excessive physical activity.
6. With prolonged exposure to low temperatures, cold paroxysmal hemoglobinuria occurs. This is quite a rare occurrence. It is completely reversible. After the body warms up, hemoglobinuria goes away. A course of treatment is required only if the process is chronic.
7. The presence of hemoglobin in the urine may be a sign of an extremely rare disease - paroxysmal nocturnal hemoglobinuria. This life-threatening pathology is accompanied by massive destruction of red blood cells, pain in the lumbar region and black urine. Such conditions in patients usually occur after sleep. Immediate blood transfusion and treatment with iron-containing medications are necessary.

Sometimes with hemoglobinuria, the presence of blood in the urine can be detected with the naked eye. Urine can have a different shade: from slightly pinkish to the color of meat slop. However, urine staining does not always indicate pathology. Urine may change color after eating red vegetables or berries.

Symptoms of hemoglobinuria may vary depending on the cause of blood in the urine. A person may experience lower back pain, aching joints, fever, and malaise. There is an enlargement of the liver and spleen. The patient's skin becomes pale or yellowish.

So, hemoglobin in the urine is positive - what does this mean? In addition to the main causes of hemoglobinuria, it can also occur in a child in certain cases:

• Phimosis in boys.
• An infection that causes a fever.
• Inflammation of the genitourinary system.
• Glomerulonephritis.
• Kidney failure.
• Tuberculosis.
• Gastrointestinal diseases.
• Transfusion of blood of the wrong type.
• Diseases of the cardiovascular system.

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The appearance of blood in the urine is one of the symptoms of pathology of the genitourinary system. This phenomenon is called hematuria. It is diagnosed in men and women, adults and children. Red blood cells in the urine are a sign of many diseases and pathological conditions.

Blood cells in urine

Blood cells - red blood cells - deliver oxygen to tissues. The body constantly renews red blood cells. And the waste elements are excreted in the feces.

Red blood cells are large cells that cannot penetrate the barrier in the kidneys. But a small part of them still ends up in the urine. This is a natural process if the urine test does not show an excess of the norm.

Blood in the urine is a consequence of urological ailments, gynecological problems, infectious, inflammatory diseases or oncology. All these violations dictate the need to see a doctor and get advice. You should not let the process take its course.

Red blood cells

Red blood cells are found in plasma and provide tissue respiration. Cells deliver oxygen to organs and remove carbon dioxide. The protein hemoglobin contains iron, which gives red blood cells their red color. Blood cells function for 3–4 months, and then are broken down by the liver.

Iron is retained in the body and can be used again, and the released protein is destroyed to form bile pigments. It is finally excreted with bile into the intestines.

Treatment

When treating hemoglobinuria, there are usually no difficulties. If the patient has a severe form of it, a blood transfusion is usually performed. In other cases, therapeutic measures consist of taking anabolic medications, as well as drugs with a high iron content and antioxidants.

Preventive measures include a diet with plenty of fruits and vegetables, taking diuretics, quitting smoking and alcohol, and constant walks in the fresh air.

What to do if the test result is positive

Normally, blood protein should not be detected in the urine. Its quantity must be zero. Only the presence of 1 - 2 red blood cells in the field of view of the microscope is allowed. These blood cells also secrete hemoglobin. However, its amount is so small that it is not detected in the study results.

Traces of hemoglobin in the urine usually indicate pathology. The reasons for this deviation may be different. A doctor can make a diagnosis based on blood protein levels. In some cases, hemoglobin may appear in urine in very small quantities during emotional experiences or after physical exertion.

Hemoglobin is usually determined during a general clinical examination of urine. There is also a rapid diagnosis of the presence of blood protein in the urine. In pharmacy chains you can find special kits for determining hemoglobin in urine. If the test result is positive, additional tests are required.

More detailed studies of urine and blood are prescribed:

• urine electrophoresis;
• study for hemosiderin and detritus in urinary sediment;
• blood clotting test (coagulogram);
• urine and blood analysis for biochemical parameters;
• bacteriological examination of urine sediment;
• test with ammonium sulfate (to determine myoglobin);
• Coombs test for antibodies to red blood cells.

In addition to laboratory research methods, ultrasound diagnostics of the kidneys and urinary tract is performed. If trauma is suspected, radiography of the excretory organs is indicated. In severe cases, a bone marrow biopsy is performed.

Therapy for hemoglobinuria depends on the etiology of the disorder. It is necessary to eliminate the cause that caused the appearance of blood in the urine. During treatment of the underlying disease, corticosteroid hormones and iron-containing drugs are prescribed.

This prevents the development of severe anemia. Vitamin therapy is also recommended. If there is a tendency to thrombosis, anticoagulants are prescribed. If hemoglobinuria occurs as a result of poisoning with various poisons, then detoxification is required. In severe cases, the patient is given a blood and red blood cell transfusion.

Hypothermia is contraindicated in patients with hemoglobinuria. Patients are also advised to drink less fluid so as not to put unnecessary strain on the kidneys.

If hemoglobin is detected in urine, you should immediately visit a doctor. A dangerous sign is also a change in the color of urine. This may be a sign of serious kidney or blood problems that require immediate treatment.

Normally, there is no hemoglobin in the urine. Isolated red blood cells may be present. Their number should not exceed 1-2 pieces in the field of view of the microscope. Of course, they contain hemoglobin, and it is released from them when they are destroyed in the urine, but its amount is so negligible that it is not detected during analysis.

Expert opinion

Kovaleva Elena Anatolyevna

Doctor-Laboratory Assistant. 14 years of experience in clinical diagnostic services.

But if hemoglobin is in sufficient quantity to be detected, especially with the naked eye (by a change in the color of urine), then we are talking about a serious kidney or blood disease.

It is necessary to find out what caused the appearance of a substance in the urine that should not be in it, and begin treatment. To do this, you will need the help of a specialist - a urologist - and a series of tests that he will prescribe.

In case of mechanical injuries and suspicion of oncology, you will also have to undergo an x-ray.

Diagnostics

The main and fundamental thing in the process of diagnosing such a disorder is taking a urine test.

In order for the analysis to be carried out objectively, it is necessary to perform a number of actions before collecting urine:

• It is necessary to carry out complete hygiene of the genital organs.
• The test jar must be absolutely clean, dry and sterilized.
• It is necessary to take the test in the morning on an empty stomach, this prevents the entry of sugars, lipids and fats.
• It is necessary to stop drinking water in the evening, this reduces the specific gravity of urine.
• You should not eat fruits (especially citrus fruits or bananas) in the evening because these foods increase the level of salts in the urine.

Laboratory assistants examine the urine, and the attending doctor interprets the analysis. Having received the analysis in their hands, many begin to study it on their own and draw conclusions based on medical reference books or the Internet. Remember that self-medication and preliminary self-diagnosis rarely lead to objective assessments of your health.

Nocturnal hemoglobinuria

If the hemoglobin level in the urine is from 10 to 25, then this indicates bleeding in the urinary organs. This analysis result can also occur in diseases accompanied by the destruction of red blood cells. Blood enters the urine through filtration in the kidneys.

If the concentration of hemoglobin in the urine is from 25 to 50, then this is a sign of blood diseases. This may also be a sign of increased myoglobin in muscle pathologies. Such indicators should seriously alarm the patient and the attending physician. To find out the cause of the pathology, it is necessary to undergo a number of additional studies.

Norm of analysis

A positive hemoglobin test result indicates the presence of either hemoglobin or myoglobin in the urine. Myoglobin is a substance very similar to hemoglobin, also of a protein nature, but it is found not in the blood, but in the muscles. Accordingly, due to the similarity of these two compounds, errors often occur during analysis.

Myoglobin in urine is found in serious diseases affecting muscle tissue. Hemoglobin - for blood diseases or bleeding in the kidneys or excretory tract. In any case, a positive test is a cause for serious concern.

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High hemoglobin levels

If hemoglobin levels in urine exceed 50, then in most cases this is due to an increase in myoglobin protein. It appears in the urine in severe muscle diseases. This may be a sign of severe injuries, extensive hematomas, as well as infectious processes in muscle tissue. With such diseases, leukocytes in the urine are usually increased.

One of the indicators characterizing the functioning of the urinary system is urobilinogen. If increased urobilinogen is detected in the urine, what does this mean? Let's figure it out.

As a result of the oxidative process, specific urobilinogen bodies are formed from bilirubin. Directly in a urine test, the so-called total urobilinogen is detected, which, in turn, consists of 2 different substances:

1. Directly from urobilinogen, which is formed from bilirubin as a result of the oxidative process taking place in the gallbladder. As part of bile, it enters the intestinal lumen. During the digestion of food, most of the urobilinogen is absorbed into the bloodstream and after some time enters the liver, from where it is partially transported back to the gallbladder through hepatocytes, and the remainder of the substance is excreted in the urine through the kidneys.
2. The second component is stercobilin, its basis is also oxidized bilirubin, but this chemical reaction takes place in the lumen of the gastrointestinal tract. First, stercobilinogen is formed from bilirubin, which is subsequently converted into stercobilin as a result of an oxidative reaction occurring in the colon. Part of it enters the bloodstream, and the rest is excreted in the feces.

It should be noted that there is quite a small amount of total urobilinogen in the blood, and accordingly, little of it is excreted in the urine. If we talk about the permissible values ​​of this substance in urine, then its amount varies from 5 to 10 mg/l.

If we talk about the function performed in the body, the presence of urobilinogen in the urine provides it with a specific yellow color. It must be remembered that if bilirubin is detected in a sample of the test material, then this is considered an unfavorable symptom, while the presence of urobilinogen is a mandatory norm.

Urine to be examined cannot be kept in the light for a long time, because urobilinogen is converted into urobilin under the influence of sunlight and in the presence of oxygen. This process is accompanied by darkening of the urine. And the result of the study will have a certain error.

Increased urobilinogen, what does this mean? As a rule, an increase in this indicator indicates the development of a pathological process in the liver, for example, cirrhosis or hepatitis. After all, a change in the functioning of this organ can lead not only to an increase in the production of bilirubin in the gallbladder, but also to a disruption in its utilization, which takes place directly in the liver.

1. Severe intoxication, which develops as a result of poisoning of the body with various toxins and toxic substances.
2. If the patient was transfused with blood that did not match the Rh group or type.
3. This symptom often appears with the development of pathological processes in the spleen.
4. Urobilinogen may increase in the urine if the hemolysis (destruction) reaction of red blood cells is activated in the body for various reasons.
5. When performing cardiac surgery to install an artificial mitral valve, an increase in urobilinogen is one of the symptoms of the patient’s body’s reaction to the foreign synthetic material used in the prosthesis.
6. In case of alcohol intoxication or liver damage as a result of chronic alcoholism.
7. This is one of the symptoms of severe enterocolitis of various origins.
8. An increase in the level of urobilinogen bodies in patients with myocardial infarction indicates the development of complications of the main pathological process. For example, the indicator begins to increase with the formation of liver failure.

However, this indicator can change in a healthy person. This happens when there is not enough fluid in the body, that is, dehydration develops. This condition can be triggered by both a decrease in the amount of fluid received and an increase in the volume of its disposal.

For a woman during pregnancy, this indicator should not deviate significantly from the norm. After all, its increase is a rather serious symptom, which indicates the development of pathology in the liver area.

These changes can be suspected even before a clinical urine test. If its color has changed from straw yellow to intensely dark, then consultation with your doctor should be carried out immediately.

Sometimes a significant increase in urobilinogen in the urine indicates the development of acute intoxication in the mother’s body, which can adversely affect the health of both the woman and the developing fetus.

True, sometimes a change in the concentration of this substance excreted in the urine can also be explained by a lack of fluid in the patient’s body. This is usually caused by an error in the diet, a lack of fluid entering the body during the day, or taking certain medications.

In any case, if a change in the color of urine is detected, a woman should immediately consult a gynecologist. He will be able to determine the cause of this phenomenon and, if necessary, make adjustments to nutrition and medications or prescribe the necessary treatment.

In a child, the level of urobilinogen in the urine should not exceed 2 mg/l. If this indicator is significantly increased, the doctor may suspect the development of the following diseases:

• the presence of stones in the gall bladder or bile ducts;
• hepatitis of various origins;
• acute or chronic cirrhosis of the liver;
• severe enterocolitis caused by both bacterial microflora and helminths;
• anemia, usually of a hemolytic nature;
• acute intoxication of the baby’s body, which can develop both under the influence of pathogenic microorganisms and during poisoning with chemicals or medications.

However, in infants, urobilinogen may also be increased as a result of physiological adaptation to environmental influences. A newborn baby often develops so-called physiological jaundice.

The reason for this phenomenon is the destruction of specific fetal hemoglobin, respectively, and the blood elements containing it - red blood cells. It is this process that causes increased urobilinogen in the urine.

However, this clinical indicator is not recorded for long and quickly returns to normal when the signs of jaundice in a newborn baby disappear. Most experts are of the opinion that this change does not relate to pathology, but is a variant of the norm.

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Normally, urobilinogen must be present in the urine. And if there is not much of it, then at least traces of it must be present. If this is not the case, the doctor may suspect the development of the following pathological conditions:

1. Lack of free flow of bile through the biliary tract. Typically this is due to a mechanical obstruction. Bile cannot enter the intestinal lumen due to obstruction (clogging) of the bile duct lumen with a stone formed in the gallbladder. The cause may also be spasms of the bile duct for various reasons.
2. The same symptom develops when the kidneys are simply unable to filter these chemicals from the bloodstream, that is, they simply do not enter the urine. This is possible in case of severe glomerulonephritis, tumor processes in the kidney area, or in case of acute intoxication of various origins.

However, in young children, urobilinogen may not be detected in the urine, and this will not be considered a deviation from the norm. In almost all children who feed on mother's milk, this chemical substance is not detected before the introduction of complementary foods.

This phenomenon can be explained very simply. In the gastrointestinal tract of a newborn child, the bacteriological and enzymatic environment that is involved in the oxidation of bilirubin has not yet formed; accordingly, urobilinogen simply is not formed.

This analysis is technically simple and is performed in almost all clinical laboratories of both private and public medical networks. This examination belongs to the so-called screening diagnostic methods. What does it mean?

However, it becomes a reason for a person’s urine, blood and feces to be sent for a more extensive examination. If necessary, other diagnostic instrumental studies are prescribed and consultations are held with specialists.

Any attending physician, for example, a therapist, pediatrician or gastroenterologist, can give a referral for a urine test for urobilinogen. The reason may be not only various symptomatic manifestations of a person’s health condition, but also a change in the characteristic color of urine.

This examination does not require any special preliminary preparation. A portion of morning urine is collected for laboratory analysis. However, delivery of the resulting material to the laboratory requires special treatment.

After all, it is known that under the influence of direct sunlight, as well as in the presence of oxygen, bilirubin in the urine will be destroyed, which can lead to a significant error in the result obtained. Therefore, urine for testing for urobilinogen must be collected in an opaque container with a tightly closed lid and quickly delivered to the laboratory.

Screening tests

Hemoglobin in the urine of a child

In childhood, the detection of hemoglobin in urine without treatment can lead to chronic diseases of the genitourinary system. The following diseases can provoke hemoglobinuria in a child:

• urolithiasis disease;
• kidney and bladder tumors;
• infectious diseases of the kidneys and urinary tract;
• increased calcium levels in urine;
• narrowing of the ureters;
• phimosis in boys;
• injuries to the excretory organs.

If a child experiences a change in the color of urine, it is necessary to urgently contact a pediatrician or pediatric nephrologist. It is necessary to conduct an ultrasound of the kidneys and bladder to identify the cause of the pathology.

There are many reasons that can contribute to the appearance of hemoglobin in a child’s urine:

• Urolithiasis disease;
• Infections affecting the kidneys;
• Infections affecting the urinary tract;
• Increased calcium levels in urine;
• Urinary tract obstruction;
• Tumor of the kidney or bladder;
• Mechanical injuries.

Reasons for appearance

The first main sign that the norm of hemoglobin in urine is disturbed is its dark red tint . This happens due to the presence of many oxyhemoglobin particles in the urine.

Urine, which was collected for analysis, is eventually divided into several layers:

• The top layer remains transparent, but retains the shade.
• The bottom layer, in it, particles of destroyed organic substances - detritus - are clearly visible.

During pregnancy

During pregnancy, the most common causes of hemoglobin in the blood are urolithiasis and urinary tract infections. At the same time, urolithiasis in women is generally more severe than in men, and even more so during pregnancy.

The fact is that sex hormones affect metabolism in such a way that women become more likely to form oxalate kidney stones, and these stones have a very complex irregular shape, due to which they severely injure surrounding tissues, causing pain and bleeding. This is how blood gets into the urine, and with it hemoglobin.

As for infections, they are also more severe in pregnant women due to the fact that a pregnant woman is severely limited in the use of antibacterial drugs that can harm the fetus.

Expert opinion

Kovaleva Elena Anatolyevna

Doctor-Laboratory Assistant. 14 years of experience in clinical diagnostic services.

Whatever the reason for the appearance of hemoglobin in the urine, the main thing for pregnant women is not to self-medicate, but to strictly follow the doctor’s instructions.

For pregnant women, the norm for blood protein in urine is no more than 0.1. If increased hemoglobin is detected in the urine, this may be a sign of kidney stones. During pregnancy, hormonal levels change.

Hemoglobin in urine in pregnant women can be observed with infectious diseases of the urinary tract. These pathologies are more severe during pregnancy, since the woman cannot take antibiotics and other medications. Hemoglobin can also appear against the background of tonsillitis or scarlet fever.