Gross hematuria in a patient with sickle cell trait

Sickle cell trait must be included in the differential diagnosis of hematuria in black patients. Therefore, diagnostic workup should include hemoglobin electrophoresis, urine culture, coagulation studies, intravenous pyelography, cystoscopy, renal ultrasonography, and renal arteriography. If the patient is found to have hemoglobin AS and no other abnormality, initial therapy consists of bed rest and intravenous fluids, with transfusion of red cells if needed. Intravenous epsilon-aminocaproic acid (EACA) has been used effectively to reverse hematuria in patients who do not respond to conservative management. In the case reported here, gross hematuria in a 24-year-old black woman resolved with use of EACA therapy.