Microscopic or occult hematuria, when reflex testing is not good laboratory practice

Paul Froom, Mira Barak

Research output: Contribution to journalReview articlepeer-review


Consensus opinion suggests that hematuria found by dipstick and not confirmed on microscopic examination (<2 erythrocytes per high power field) signifies a false-positive reagent strip test result. Standard practice is to repeat the dipstick test several days later and if still positive to confirm by microscopic examination. If discordant results are obtained, experts recommend reflex testing for urinary myoglobin and hemoglobin concentrations. The question is whether or not this approach represents good laboratory practice. These recommendations are not evidence based. We conclude that the reference range for red blood cells on the reagent strip should be increased to 25×10 6 cells/L for young men, and 50×106 cells/L for the rest of the adult population, ranges consistent with flow cytometry reports. Confirmation reflex testing using tests that have inferior sensitivity, precision and probably accuracy is not recommended.

Original languageEnglish
Pages (from-to)271-273
Number of pages3
JournalJournal of Nephrology
Issue number3
StatePublished - May 2010
Externally publishedYes


  • Good laboratory practice
  • Hematuria
  • Microscopic
  • Occult
  • Reflex testing


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