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What could be the reason behind blood in the urine?

Q: One of my cousins is a 50 years old female, who had menopause few months back. She spotted blood in her urine one morning and was taken to a doctor. The doctor diagnosed it as a urinary tract infection and prescribed Ciprofloxacin, 500 mg, twice daily. The bleeding stopped after 12 hours, after receiving 2 doses of the antibiotic. The urine culture showed E.coli infection and the ultrasound picture showed normal kidneys and ureters. In the urine, there were not many RBCs (0-2%)and doctors expressed surprise on finding few RBCs. Other parameters were normal. The doctor has asked for cytologic examination of the urine now. She had similarly noted blood in urine about 4 years back and was treated with cipro at that time as well. Should she be investigated for any other problem? If yes, what should she be suspected of having haematuria? Can E.coli infection alone be the cause of bleeding? Is there any reason for worry? Should she get tested for any thing else? After this episode the patient is complaining of weakness and occasional breathlessness. Is this related to the problem or just a sign of anxiety?

A:The sight of blood will certainly make any one anxious as you and your sister would be. In your sisters case it does not appear to be a serious problem. In females less than 5 RBCs are taken as normal. Best advice is to keep her urinary tract infection under full contol and keep under surveillance for any further bleeding. If it recurs your urologist would certainly take appropriate investigations to rule out other causes of bleeding.

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