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Monday, July 24, 2017
Very high LDH, what follow-up tests needed?
Hello, I could not find a topic for my question, so I will ask it here because I am a female, who is ill. My doctor found that my LDH (lactate dehydrogenase) level was very high (about 100 points above normal). Could you please explain if a high LDH could be found in Muscular Dystrophy or Lyme disease? My doctor is looking for answers to my muscle aching and problems moving my legs, so what follow up tests might he order?
Lactic Dehydrogenate (LDH) is an enzyme that can be found typically in the liver, muscle, kidney, heart, brain, lungs, and red blood cells. Elevated levels typically indicate some type of tissue damage.
So, your doctor can order
- other liver function tests (to make sure that your liver is not damaged),
- other muscle enzymes (such as aldolase or creatinine kinase), and
- a complete blood count (to make sure you do not have hemolytic anemia).
The first step with any abnormal value is to repeat the test to make sure it isn't a false positive. LDH can also be "fractionated" into five different isoenzymes, which help figure out where the elevated LDH is coming from.
For example, LDH-1 is from the heart, LDH-2 is from the immune system, LDH-3 is in the lungs and other tissues, LDH-4 is in the kidney and pancreas, and LDH-5 is in the liver and muscle. That will help your doctor pinpoint the cause for your elevated LDH.
As you noted, the fact that you are having problems with your muscle aching, the blood tests mentioned above can help. Sometimes an MRI is necessary to look more closely at the leg muscles, and sometimes a biopsy of the muscle can help determine whether the muscle is inflamed.
W. Fred Miser, MD
Professor of Family Medicine
Director of Ohio State Medicine Residency Program
College of Medicine
The Ohio State University