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Research Lactate Dehydrogenase (LDH or LD)
Blood Health

Lactate Dehydrogenase (LDH or LD)

Other names: LACTIC ACID DEHYDROGENASE

Optimal Result: 121 - 224 U/L.

Lactate dehydrogenase (LDH) is an essential enzyme found in nearly every living cell. It plays a primary role in energy production, specifically in glycolysis—the process by which cells convert sugar into energy. During glycolysis, LDH facilitates the conversion of pyruvate into lactate, a crucial step when oxygen levels are low, such as during intense exercise or in specific health conditions.

LDH exists in five distinct forms, called isoenzymes (LDH-1 through LDH-5), which are distributed across different tissues like the heart, liver, muscles, and kidneys. Each isoenzyme is associated with specific organs or tissues: for example, LDH-1 is abundant in the heart, while LDH-5 is found in the liver and skeletal muscle. Analyzing these specific isoenzymes can sometimes help pinpoint the location of tissue damage.

Elevated LDH levels in the blood can signal tissue damage or disease, as cells release LDH when they are injured or destroyed. In clinical settings, high LDH levels serve as an important diagnostic tool to help detect and monitor various health conditions, including heart attacks, liver disease, muscle injuries, and certain types of cancer. Elevated LDH levels are also valuable in oncology, as they can indicate tumor progression or a response to treatment, with cancer cells releasing LDH when they die.

Additionally, increased LDH levels can help diagnose infections and inflammatory conditions. For instance, bacterial infections, viral hepatitis, and autoimmune diseases may elevate LDH levels, reflecting the body’s response to these conditions. Chronic diseases, like certain types of anemia (especially hemolytic anemia), are also associated with high LDH, aiding in differentiating between types of anemia and other blood disorders.

Notably, recent research has linked elevated LDH levels with severe cases of COVID-19. In COVID-19 patients, high LDH levels may correlate with significant lung involvement and a greater need for respiratory support, making LDH a useful marker in assessing disease severity.

While LDH levels alone cannot specify the exact location of tissue damage, they serve as a valuable marker when combined with other diagnostic tests. By measuring LDH, healthcare providers gain a comprehensive view of tissue health, disease progression, and potential tissue damage.

References:

  1. Henry, J.B., Clinical Diagnosis and Management by Laboratory Methods, 21st ed., Saunders, 2007.
  2. Rifai, N., Horvath, A.R., Wittwer, C.T., Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 6th ed., Elsevier, 2018.
  3. Apple, F.S., Wu, A.H., "Biomarkers for Acute Cardiovascular Diseases," Biochemical Society Transactions, 2001.
  4. Burtis, C.A., Ashwood, E.R., Bruns, D.E., Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics, 7th ed., Saunders, 2014.
  5. Hoffman, R., Benz, E.J., Silberstein, L.E., Hematology: Basic Principles and Practice, 6th ed., Elsevier, 2012.
  6. Schmitt, Y., et al., "Lactate dehydrogenase release as a biomarker of cellular death," Biosensors and Bioelectronics, 2019.
  7. Farhana, A., Lappin, S.L., "Biochemistry, Lactate Dehydrogenase," StatPearls, 2024. Available at: NCBI Bookshelf
  8. Lactate Dehydrogenase (LDH) Test, MedlinePlus, MedlinePlus LDH Test

What does it mean if your Lactate Dehydrogenase (LDH or LD) result is too high?

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.

What does it mean if your Lactate Dehydrogenase (LDH or LD) result is too low?

Low levels of lactate dehydrogenase (LDH) in the blood are uncommon and usually not considered harmful. However, they can indicate a few potential conditions:

LDH deficiency: This is a rare genetic disorder that can occur in two forms:

- LDH-A deficiency (also known as glycogen storage disease XI): This type causes symptoms such as fatigue, muscle pain, cramping during exercise (exercise intolerance), and in some cases, muscle breakdown. It may also lead to red or brown urine due to myoglobin breakdown and potential kidney damage.

- LDH-B deficiency: People with this type typically do not experience any signs or symptoms. They are usually discovered only through routine blood tests that reveal reduced LDH activity.

Vitamin C excess: Consuming large amounts of ascorbic acid (vitamin C) may lead to lower LDH levels.

Pesticide exposure: Some studies have shown that exposure to pesticides, especially without adequate protective gear, may result in lower LDH levels.

It's important to note that while low LDH levels are rare, they don't necessarily indicate a health problem in all cases. LDH-B deficiency, for example, doesn't appear to cause any health issues despite the reduced enzyme activity .If you have low LDH levels, your healthcare provider will likely consider these possibilities along with your overall health status and any symptoms you may be experiencing to determine if further investigation or treatment is necessary.

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