What if they are on anticoagulants or antiplatelet therapy?

• You should not assume the haematuria is because of anti-coagulant or anti-platelet therapy
• Patients should be evaluated regardless of these medications.

Investigations:

• Dipstick – any proteinuria as well?
• MSSU for MC&S – guides antibiotic selection if UTI 
• 24h urine creatine clearance & urinary protein excretion – re: is there renal impairment?
• Bloods – U&E (for renal function), FBC (if any anaemia), clotting screen
• KUB x-ray vs IVU vs USS

Management: NICE says…

urgent 2ww suspected cancer referral if…

• aged 45 and over and have:
  • 1. unexplained visible haematuria (i.e. no UTI)
    2. visible haematuria that persists or recurs after successful treatment of urinary tract infection
• aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test
• consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection (i.e. suspected bladder cancer)