Blood in the urine, called hematuria, is a common urinalysis finding and is usually not caused by a serious problem. It can appear in two places on a report. The dipstick grades blood from trace to large, and the microscope counts red blood cells, as in “RBC 5-10/hpf.”
This article explains what a positive blood result on a urine test means and why the dipstick and the red blood cell count can disagree. It also describes the common causes of blood in the urine and how doctors decide which results need further tests.
The reference range that applies to your result is the one printed on your laboratory report, not the typical ranges shown here. Reference ranges vary between laboratories based on the equipment used, the population tested, and individual factors such as age, sex, and pregnancy status. Always compare your result to the reference range printed on your own report, and discuss any abnormal (or unexpectedly normal) result with your doctor.
Urine tests for blood look for red blood cells that have entered the urine somewhere between the kidneys and the outside of the body. Two parts of a urinalysis check for blood, and they work differently.
Blood that turns urine pink, red, or cola-colored is called visible, or gross, hematuria. Blood that can only be found by testing is called microscopic hematuria.
A positive dipstick for blood and a normal red blood cell count on the same urinalysis is a common and confusing combination. It happens because the dipstick reacts to hemoglobin, not to whole cells, and the two findings mean different things.
The opposite pattern also happens. Large doses of vitamin C can make the dipstick read negative even when red blood cells are present. For these reasons, guidelines from the American Urological Association (AUA/SUFU, 2020, amended 2025) say blood in the urine should not be diagnosed from a dipstick alone. A positive dipstick should prompt a microscopic examination, and the red blood cell count guides the next steps.
A urine test for blood uses an ordinary clean-catch, midstream urine sample collected in a sterile cup. Because menstrual blood and blood from a recent procedure can enter the sample, the test is often timed to avoid them. If the first result may have been affected by a period, hard exercise, or contamination, a repeat sample is usually collected a few days later.
Urine blood results are read by looking at the dipstick grade and the red blood cell count together.
Blood in the urine has many possible causes, and most are not serious. Common and usually harmless causes include:
Other causes of blood in the urine need a closer look:
Blood-thinning medicines do not, on their own, explain blood in the urine. People taking them are usually checked in the same way as everyone else.
In adults, persistent blood in the urine is sometimes investigated to ensure there is no problem in the kidney or bladder, including a tumor. This is a careful step, not a sign that cancer is expected. In studies of adults evaluated for microscopic hematuria, about 2 to 4 in 100 had bladder cancer, while the other 96 to 98 did not.
Under the AUA/SUFU guideline, the decision depends mainly on your age and smoking history. It also depends on how much blood is present and whether it keeps coming back on repeat tests.
People at the lowest risk usually need only a repeat urinalysis. Others may have an ultrasound or CT scan of the kidneys and a cystoscopy, a look inside the bladder with a thin camera. A urine cytology test, which looks for abnormal cells in the urine, is sometimes added in selected situations. Visible blood is more likely to be investigated than microscopic blood.
What happens after a positive urine test for blood depends on the red blood cell count, your symptoms, and the other results on the urinalysis. A microscopic examination or a repeat urinalysis usually follows a positive dipstick. A urine culture may be done if infection is possible, and blood tests of kidney function or a urine albumin test may be added if protein or casts are present. Your doctor may refer you to a urologist for bladder and kidney problems, or to a nephrologist for problems with the kidney filters.