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Positive Dipstick Heme Results Appear to Need More Scrutiny

Minority of group referred for nonmacroscopic hematuria were found to have it by urologist

THURSDAY, Feb. 4 (HealthDay News) -- Patients testing positive on dipstick heme tests should have confirmation with microscopic urinalysis before they're further evaluated or referred to a urologist, according to research published in the February issue of The Journal of Urology.

Pravin K. Rao, M.D., of the Cleveland Clinic, and colleagues analyzed data from 91 patients who were referred for asymptomatic, nonmacroscopic hematuria. Sixty-nine of the patients were referred to urology without documentation of true microhematuria, meaning they were referred based on dipstick alone or with a microscopic urinalysis before the referral that found fewer than three red blood cells per high power field.

Of these 69 patients, the researchers discovered that 17 (25 percent) had true microhematuria. The remaining 52 had so-called "dipstick pseudohematuria." Of this group of 52, 25 patients had already undergone imaging before their referral or chose to be evaluated due to concerns of malignancy, even though American Urological Association guidelines didn't suggest further testing. Patients referred for microscopic pseudohematuria were subject to more than $500 apiece in needless imaging costs.

"Given the high costs of care, the concern about an inadequate urological work force, and the morbidity and cost of unnecessary and/or inappropriate care, innovative solutions to such problems are needed. Solutions are plentiful including referring provider education and referral systems that mandate appropriate evaluation before referral is scheduled," writes the author of an accompanying editorial.

A co-author reported financial or other relationships with several pharmaceutical and other companies.

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