Hemorrhagic cystitis

Hemorrhagic cystitis: Description, Causes and Risk Factors: Hemorrhagic cystitisBladder inflammation with macroscopic hematuria. Generally the result of a chemical or other traumatic insult to the bladder. Hemorrhagic cystitis is the sudden onset of hematuria combined with bladder pain and irritative bladder symptoms. Hematuria is blood in the urine. The amount of blood can range from a minute amount that occurs occasionally to frank bright red blood that occurs continuously. There are a variety of causes of hematuria. Oncology patients are at high risk for developing hemorrhagic cystitis. The onset can be variable. Hemorrhagic cystitis can occur during treatment, immediately following treatment, or the onset may be delayed for months following treatment. While hemorrhagic cystitis can be a very serious condition leading to significant bleeding (hemorrhage) or life-threatening infection (urosepsis), the majority of patients can be treated successfully. Common risk factors: Chemotherapy medications.
  • Bladder cancer.
  • Pelvic radiation therapy.
  • Radiation therapy given with chemotherapy.
  • AID (acquired immunodeficiency disease).
  • Other chemicals (for example, dyes, insecticides, and recreational drugs).
  • Antibiotics.
  • Viruses (for example, papovavirus and adenovirus).
  • Persistent urinary tract infections (UTIs).
  • Thrombocytopenia (low platelet count).
  • Bone marrow transplant (BMT).
  • Other chemotherapeutic agents, while not usually associated with bladder toxicity, might also put a patient at risk.
The exact prevalence is unknown as very few cases are being reported. Symptoms: Symptoms include: Hematuria (blood in the urine).
  • Abdominal discomfort.
  • Pain or burning when passing your urine.
  • Feeling like you are unable to empty your bladder.
  • Loss of bladder control (incontinence).
  • Frequent or urgent need to empty your bladder.
  • Getting up several times a night to pass your urine.
Diagnosis: In all patients, obtain a complete blood count (CBC), basic metabolic profile (BMP, SMA-7), liver function tests, renal function tests, and coagulation studies. The hematocrit is rarely below the reference range during an initial occurrence of hemorrhagic cystitis; however, patients with chronic hemorrhagic cystitis may have a lower hematocrit level and prevailing signs of chronic anemia. The white blood cell (WBC) count may be elevated because of a concurrent infection or because of the treatment (Ex: chemotherapy) of the underlying malignancy. Imaging of the upper tracts and bladder is recommended in all cases of hemorrhagic cystitis to assist in ascertaining the etiology and/or confounding variables. At a minimum, perform bladder and renal ultrasonography with a KUB (kidney, ureter, bladder) to assess for radio-opaque stones. Cystoscopy is indicated in all but straight-forward cases of uncomplicated bacterial cystitis. If a bacterial infection is documented, voiding cystourethrography (VCUG) may be performed, if indicated, after the infection has been cleared. Imaging tests may include: Renal ultrasonography.
  • CT scanning without contrast (stone protocol, prone scanning).
  • Intravenous pyelography.
  • Magnetic resonance (MR) urography.
  • CT urography.
Other tests: Viral and bacterial cultures as needed. Treatment: Hemorrhagic cystitis can lead to severe blood loss and is taken very seriously. Open ulcers in the bladder can provide a portal for bacteria to pass into your bloodstream. It may also lead to permanent scarring of the lining of the bladder, which could cause blockage of the urinary tract or bladder constriction. Therefore, prompt treatment of this condition is necessary. Other treatment options include: Symptom relief and pain control.
  • Platelet transfusions to help control bleeding.
  • Blood transfusions if the bleeding has caused anemia.
  • Antibiotic or antiviral therapy if the cause of the cystitis is infectious in nature.
  • Irrigation of the bladder with a saline solution to prevent clots, or medications to control bleeding.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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