Order Code
2224
Preferred Specimen
Collect 2 mL of serum using an SST tube. Allow the sample to clot in an upright position for at least 30 minutes before centrifuging within 2 hours of collection. Store refrigerated.
ContainerType
Serum separator tube
Alternate Specimen Requirements
Obtain 2 mL of serum in a plain red top tube. Allow the sample to clot upright for a minimum of 60 minutes, then centrifuge and transfer the serum to a plastic transport tube within 2 hours. Ensure the tube is clearly labeled as serum from a plain red top tube. Refrigerate promptly.
Minimum Volume
1 mL
Transport Temperature
Refrigerated
Expected Turnaround Time
1 day
Specimen Stability
7 days room temperature; 4 days refrigerated; 6 weeks frozen
Methodology
Roche COBAS uv assay (lactate to pyruvate) acc. To ifcc Note: STAT or regional laboratory testing may use different methodology and/or manufacturer
Rejection Criteria
- Moderate or greater hemolysis
Overview
Lactate dehydrogenase (LD) is a cytoplasmic enzyme that catalyzes the conversion of L-lactate and NAD to pyruvate and NADH, the final step in anaerobic glycolysis (NCBI 2018). It plays a critical role in providing energy under low oxygen conditions. Elevated LD levels serve as a nonspecific indicator of tissue injury or cellular destruction (Longo 2012). Increased LD can be observed in a variety of conditions causing hypoxia and tissue damage, including hemolysis, systemic shock, hypotension, renal infarction, hepatitis, heart failure, myocarditis, pancreatitis, rhabdomyolysis, gastrointestinal obstruction, myocardial infarction, seizures, myopathies, tumor lysis syndrome, and pulmonary infarction.
LD deficiency is an exceptionally rare disorder (NCBI 2018; Miyajima 1993), clinically characterized by exercise intolerance, erythematous skin eruptions, and uterine stiffness during labor (Nazzari 1992).
Clinical Significance
- Determine severity of tissue damage and hypoxia
- Evaluate red blood cell hemolysis
- In combination with plasma free hemoglobin
- Causes: Inherited hemolytic anemias (spherocytosis, sickle cell disease); acquired hemolytic anemias (microangiopathic hemolytic anemia, PNH, immune hemolysis); prosthetic heart valves; myelofibrosis
- Evaluate megaloblastic anemias
- Including pernicious anemia (B12 deficiency), folate deficiency
- Screen HIV patients for Pneumocystis pneumonia
- Evaluate extent of tumor lysis syndrome
- Evaluate leukemia/lymphoma
- Tumor marker that is helpful in prognosis
- Suggests tumor bulk
- Staging for primary germ cell tumors of testicular cancer
- Used in combination with alpha-fetoprotein, hCG
- Myocardial infarction (less commonly used)
- Rises 10 hours after infarction and peaks at 24 to 48 hours; remains elevated for 6 to 8 days
- Troponins are more specific so LD is not used clinically
- Evaluate hepatitis
- Acute hepatitis, ischemic or hepatic congestion from heart failure
Additional Information
Because LD is a nonspecific marker of tissue damage, it is often interpreted alongside other laboratory values to pinpoint organ-specific injury. For example, in infectious mononucleosis, LD levels are typically higher than AST, often accompanied by an isomorphic LD isoenzyme pattern. Conversely, viral hepatitis usually presents with more marked increases in AST and ALT compared to LD. In ischemic hepatitis, serum LD can be significantly elevated—sometimes surpassing AST and ALT levels (Aboulsoud 2017)—but it normalizes rapidly. The early and substantial rise in LD can assist in distinguishing ischemic hepatitis from viral hepatitis (Ciobanu 2018). In patients with biliary pancreatitis, an LDH:AST ratio greater than 18 has been proposed as a marker of pancreatic necrosis and is associated with a poorer prognosis (Schwartz 1991).
LD may also increase in cardiac conditions such as myocardial infarction or pericarditis. While LD can serve as a tumor marker in specific contexts, it is not utilized as a general cancer screening tool. Serum LD concentration correlates with tumor burden and disease stage in Hodgkin’s and non-Hodgkin lymphoma (Sandlund 1996). Elevated pretreatment LD levels are recognized as adverse prognostic factors in non-Hodgkin lymphoma and small cell lung carcinoma (Stokkel 1998). Increased LD can also be observed in germ cell tumors like ovarian dysgerminoma, testicular seminoma, neuroblastoma, and various other malignancies. In multiple myeloma, high LD levels have been linked to drug resistance and tumor burden. Monitoring LD over time can help assess response to chemotherapy (Dimopoulos 1991).
Limitations
Artifactual (poor collection) as well as clinical (in vivo) hemolysis elevates LD results; hemolyzed specimens should be rejected. Bilirubin and Intralipid can also cause LD elevations.
References
Aboelsoud MM, Javaid AI, Al-Qadi MO, Lewis JH. Hypoxic hepatitis – its biochemical profile, causes and risk factors of mortality in critically-ill patients: A cohort study of 565 patients. J Crit Care. 2017;41:9-15.28460210
Esteves F, Calé SS, Badura R, et al. Diagnosis of Pneumocystis pneumonia: evaluation of four serologic biomarkers. Clin Microbiol Infect. 2015;21(4):379.e1-10.25630458
Ciobanu AO, Gherasim L. Ischemic Hepatitis – Intercorrelated Pathology. Maedica (Buchar). 2018;13(1):5-11.29868133
Dimopoulos MA, Barlogie B, Smith TL, Alexanian R. High serum lactate dehydrogenase level as a marker for drug resistance and short survival in multiple myeloma. Ann Intern Med. 1991;115(12):931-935.1952489
Hamrick RM 3rd, Murgo AJ. Lactate dehydrogenase values and bone scans as predictors of bone marrow involvement in small-cell lung cancer. Arch Intern Med. 1987;147(6):1070-1071.3036032
Longo, EL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012.
Miyajima H, Takahashi Y, Suzuki M, Shimizu T, Kaneko E. Molecular characterization of gene expression in human lactate dehydrogenase-A deficiency. Neurology. 1993;43(7):1414-1419.8327147
National Center for Biotechnology Information (NCBI). LDHA lactate dehydrogenase A [Homo sapiens (human)]. Gene [database online]. https://www.ncbi.nlm.nih.gov/gene/3939. Updated November 24, 2018. Accessed December 4, 2018.
Nazzari G, Crovato F. Annually recurring acroerythema and hereditary lactate dehydrogenase M-subunit deficiency. J Am Acad Dermatol. 1992;27(2 Pt 1):262-263.1430368
Sandlund JT, Downing JR, Crist WM. Non-Hodgkin’s lymphoma in childhood. N Engl J Med. 1996;334(19):1238-1248.8606720
Schwartz MK. Lactic dehydrogenase. An old enzyme reborn as a cancer marker? Am J Clin Pathol. 1991;96(4):441-443.1892120
Stokkel MP, van Eck-Smit BL, Zwinderman AH, Willems LN, Pauwels EK. Pretreatment serum LDH as additional staging parameter in small-cell lung carcinoma. Neth J Med. 1998;52(2):65-70.9557528
Vanderlinde RE. Measurement of total lactate dehydrogenase activity. Ann Clin Lab Sci. 1985;15(1):13-31.3882046
Alias
- Lactate dehydrogenase
- Lactic dehydrogenase (LDH)
Test Setup Days
Monday through Friday PM shift
CPT
83615 LOINC: 14804-9
Reference Range
AGE AND GENDER SPECIFIC RANGES
ADULT RANGE
FEMALE: 135-214 U/L
MALE: 135-225 U/L
| UNIT CODE | UNIT CODE NAME | ANALYTE | GENDER | AGE | REFERENCE RANGE | Units of Measure |
|---|---|---|---|---|---|---|
| 2224 | LDH | LDH | NOT SPECIFIED | 0Y | 135-225 | U/L |
| 2224 | LDH | LDH | NOT SPECIFIED | 20D | 225-600 | U/L |
| 2224 | LDH | LDH | NOT SPECIFIED | 1Y | NOT ESTAB. | U/L |
| 2224 | LDH | LDH | NOT SPECIFIED | 15Y | 120-300 | U/L |
| 2224 | LDH | LDH | NOT SPECIFIED | 150Y | 135-225 | U/L |
| 2224 | LDH | LDH | MALE | 0Y | 135-225 | U/L |
| 2224 | LDH | LDH | MALE | 20D | 225-600 | U/L |
| 2224 | LDH | LDH | MALE | 1Y | NOT ESTAB. | U/L |
| 2224 | LDH | LDH | MALE | 15Y | 120-300 | U/L |
| 2224 | LDH | LDH | MALE | 150Y | 135-225 | U/L |
| 2224 | LDH | LDH | FEMALE | 0Y | 135-214 | U/L |
| 2224 | LDH | LDH | FEMALE | 20D | 225-600 | U/L |
| 2224 | LDH | LDH | FEMALE | 1Y | NOT ESTAB. | U/L |
| 2224 | LDH | LDH | FEMALE | 15Y | 120-300 | U/L |
| 2224 | LDH | LDH | FEMALE | 150Y | 135-214 | U/L |