Approach to managing haematuria in palliative care
In patients with palliative care needs, haematuria of a minor degree may occur with many conditions, including urinary tract infection. Haematuria that is sudden or severe (eg with passage of clots) is often associated with an underlying cancer. If haematuria is significant, urinary retention from clotted blood can occur.
Management of haematuria depends on the cause and severity, particularly if symptoms are present. Consider the potential benefits and burdens of treatment, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. Management options, as appropriate, include:
- assessing for and managing any treatable causes of haematuria (eg treating infection, stopping antiplatelet or anticoagulant therapy)
- correcting clotting abnormalities (including disseminated intravascular coagulation), if feasible, or overanticoagulation—see the Cardiovascular guidelines
- referring for cystoscopy to determine the site of the bleeding, to evacuate clots, and for definitive treatment with cautery
- attempting to control haemorrhage with palliative radiotherapy to the bladder if the bleeding is cancer-related
- inpatient manual evacuation of clots followed by bladder irrigation for patients with clot retention
- reassurance—this may be sufficient for some patients with microscopic haematuria or rose-coloured urine.
Blood transfusions may be required for symptomatic anaemia—see Anaemia in palliative care.