Lactate dehydrogenase (LDH) is an important enzyme found in nearly all living cells, playing a critical role in converting sugar into energy. This enzyme is pivotal in the process of glycolysis, where it helps convert pyruvate, the end product of glycolysis, into lactate when oxygen is scarce. This reaction is essential for energy production, especially in conditions where oxygen levels are low, such as during intense exercise. LDH exists in five different forms, known as isoenzymes, which are found in different tissues of the body. Elevated levels of LDH in the blood can be an indicator of tissue damage or disease, as cells release LDH when they are damaged or destroyed. Therefore, measuring LDH levels can be useful in diagnosing and monitoring conditions such as heart attacks, liver disease, muscle injury, and certain types of cancer. Because LDH is widely present in various tissues, its levels alone cannot pinpoint the exact location of damage, but it serves as a valuable marker in conjunction with other tests to provide a comprehensive understanding of a patient's health.
References:
- Henry, J.B., "Clinical Diagnosis and Management by Laboratory Methods," 21st edition, Saunders, 2007.
- Rifai, N., Horvath, A.R., Wittwer, C.T., "Tietz Textbook of Clinical Chemistry and Molecular Diagnostics," 6th edition, Elsevier, 2018.
- Apple, F.S., Wu, A.H., "Biomarkers for Acute Cardiovascular Diseases," Biochemical Society Transactions, 2001.
-Burtis, C.A., Ashwood, E.R., Bruns, D.E., "Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics," 7th edition, Saunders, 2014.
- Hoffman, R., Benz, E.J., Silberstein, L.E., "Hematology: Basic Principles and Practice," 6th edition, Elsevier, 2012.
- Schmitt, Y., et al., "Lactate dehydrogenase release as a biomarker of cellular death," Biosensors and Bioelectronics, 2019.
- Farhana A, Lappin SL. Biochemistry, Lactate Dehydrogenase. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557536/
- Lactate Dehydrogenase (LDH) Test, https://medlineplus.gov/lab-tests/lactate-dehydrogenase-ldh-test/
- MedlinePlus. Lactate Dehydrogenase (LDH) Test (https://medlineplus.gov/lab-tests/lactate-dehydrogenase-ldh-test/).
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What elevated LDH levels might signify: Elevated levels of lactate dehydrogenase (LDH) in the blood typically indicate some form of tissue damage or cellular injury. When cells are damaged or destroyed, LDH is released into the bloodstream. Therefore, high LDH levels serve as a general marker for cell damage but do not specify the exact location or cause of the damage.
The damage is usually from disease, infection, or injury. Your provider may order more tests to diagnose your condition.
But higher a than normal LDH level doesn't always mean you have a medical condition that needs treatment. High levels can be caused by intense exercise and certain medicines, including aspirin. It's also possible to have a high LDH level if many red blood cells broke open when your sample was collected and tested.
Conditions Associated with Elevations:
→ Heart Diseases:
- Myocardial infarction (heart attack)
- Congestive heart failure
→ Liver Diseases:
- Hepatitis
- Cirrhosis
→ Cancer:
- Lymphomas
- Leukemias
- Germ cell tumors
→ Muscle Diseases:
- Muscular dystrophy
- Rhabdomyolysis
→ Other Conditions:
- Hemolytic anemia
- Acute pancreatitis
- Infections (e.g., mononucleosis, sepsis)
- Kidney disease
Possible Reasons for Elevation:
- Tissue Damage: Any condition that leads to cell injury, such as physical trauma, surgery, or burns.
- Hypoxia: Situations where tissues are deprived of oxygen, such as in severe anemia or respiratory disorders.
- Malignancies: Certain cancers can cause elevated LDH due to rapid cell turnover.
- Inflammation: Diseases causing systemic inflammation can result in elevated LDH levels.
- Intense Physical Activity: Strenuous exercise can cause temporary increases in LDH due to muscle breakdown.
Potential Treatment Considerations:
- Treat Underlying Cause: Addressing the root cause of the elevated LDH is critical, whether it is treating an infection, managing cancer, or supporting heart function.
- Monitor Levels: Regular monitoring of LDH levels can help assess the effectiveness of treatment and disease progression.
- Supportive Care: Depending on the underlying condition, supportive care such as hydration, rest, and specific therapies (e.g., chemotherapy for cancer) may be required.
Other Correlated Biomarkers:
- Creatine Kinase (CK): Often elevated in muscle damage.
- Aspartate Aminotransferase (AST): Elevated in liver disease and muscle damage.
- Alanine Aminotransferase (ALT): Primarily elevated in liver conditions.
- Troponin (or Troponin T, High Sensitivity) : Used to diagnose heart attacks specifically.
- C-reactive protein (CRP) (or hsCRP): Indicates inflammation.
Nutrient Associations:
- Vitamin B Complex: Essential for energy metabolism, potentially impacting LDH activity.
- Antioxidants (e.g., Vitamin C, E): May help reduce oxidative stress and cell damage.
- Iron: Important for preventing anemia and associated tissue hypoxia.
Specific Considerations:
- Males vs. Females: Generally, LDH levels are similar across genders, but certain conditions causing elevation may be more prevalent in one gender (e.g., prostate cancer in males).
- Young vs. Old: Younger individuals may have higher baseline levels due to growth and development, whereas older individuals might have elevated levels due to age-related diseases or conditions.
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Abnormally low LDH levels occur only rarely and usually aren’t harmful.
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11dhTxB2/Creatinine (AspirinWorks), Absolute Reticulocytes, Alpha-1 Antitrypsin Phenotype, Alpha-1-Antitrypsin, Serum, Ammonia, Angiotensin-1-Converting Enzyme, Beta-2 Glycoprotein I Ab, IgA, Beta-2 Glycoprotein I, IgG, Beta-2 Glycoprotein I, IgM, Bicarbonate (HCO3), Serum, Blood Type, C-Reactive Protein (CRP), C-Reactive Protein, Cardiac, Copper, Serum or Plasma, D-Dimer, D-Dimer, Quantitative, Delta Aminolevulinic Acid, Urine, 24 Hour, Erythropoietin (EPO), Serum, F2-Isoprostane, Factor IX Activity, Factor V Leiden Mutation, Factor VII Activity, Factor VIII Activity, Factor X Activity, Factor XI Activity, Ferritin, Ferritin (female range), Fibrinogen Activity, Fibrinogen Antigen, Glucose 6-Phosphate Dehydrogenase (G6PD), Quantitative, Haptoglobin, Hemoglobin A, Hemoglobin F, Immatue Reticulocyte Fraction, Immature Platelet Fraction, Immature Retic Fraction, Iron, IRON (Serum), Lactate Dehydrogenase (LDH or LD), Large Unstained Cells (LUC), Large Unstained Cells (Percent), Macrocytosis, Magnesium, RBC, Nucleated RBC (NRBC) (%), Nucleated red blood cell (NRBC), OxPL-apoB1, Plasminogen Activator Inhibitor 1 (PAI-1) Activity, Platelet Ab, Indirect (IgA), Platelet Ab, Indirect (IgG), Platelet Ab, Indirect (IgM), Plateletcrit (PCT), Polychromasia, Porphobilinogen Deaminase, Whole Blood, Porphyrins, Total Serum, PTT-LA Screen, Retic Hgb Equivalent, Reticulocyte Count, Reticulocyte hemoglobin, Reticulocyte, Absolute, Sickle Cell Screen, Stomatocytes, Thrombin Antithrombin Complex, Thrombocytes, Total iron-binding capacity (TIBC), Transferrin, Transferrin Receptor, Transferrin saturation (Iron Saturation), UIBC
