Done 12 weeks treatment and now elevated LDH enzymes

[strangerbynight]

So I am cured almost 2 months but my doctor just ordered a blood test just for a follow-up, everything is in normal range including LFT but my LDH is high 281, normal range is 110-215, I am freaking out now, any ideas? My doctor only told me that we are going keep an eye on it, he did not mention about getting another test done..

[Lynn K]

Found the following information about LDH. I just looked at my test results and apparently I have never had this test.

Sounds like it could be a lot of things and your results are just slightly above normal I am sure if your results were more elevated your doctor would be more concerned than just monitoring your results.

https://labtestsonline.org/understanding/analytes/ldh/tab/test/

Also known as: LDH
Formal name: Lactate Dehydrogenase
Related tests: Comprehensive Metabolic Panel, Haptoglobin, Liver Panel, CSF Analysis, Body Fluid Analysis, Pleural Fluid Analysis, Pericardial Fluid Analysis, Peritoneal Fluid Analysis, Tumor Markers
Board approvedAll content on Lab Tests Online has been reviewed and approved by our Editorial Review Board.

At a Glance
Test Sample
The Test
Common Questions
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The Test

How is it used?
When is it ordered?
What does the test result mean?
Is there anything else I should know?
How is it used?
A lactate dehydrogenase (LD or LDH) test is a non-specific test that may be used in the evaluation of a number of diseases and conditions. LD is an enzyme that is found in almost all of the body's cells (as well as in bacteria) and is released from cells into the fluid portion of blood (serum or plasma) when cells are damaged or destroyed. Thus, the blood level of LD is a general indicator of tissue and cellular damage. The level of LD may also rise in other types of body fluids (e.g., cerebrospinal fluid, pleural fluid, etc.) in the presence of certain diseases.

An LD blood test may be used:

As a general indicator of the existence and severity of acute or chronic tissue damage
To detect and monitor progressive conditions such as anemia, including hemolytic anemia and megaoloblastic anemia, or severe infections
To help stage, determine prognosis, and/or monitor treatment (i.e., chemotherapy) of cancers, such as germ cell tumors (e.g., some types of testicular cancer and ovarian cancer), lymphoma, leukemia, melanoma, and neuroblastoma
An LD test is performed on body fluids for a few different reasons:

To help evaluate cerebrospinal fluid and distinguish between bacterial or viral meningitis
To evaluate other body fluids such as pleural, peritoneal or pericardial fluid and help determine whether the accumulation of fluid is due to injury and inflammation (exudate) or due to an imbalance of pressure within blood vessels and the amount of protein in the blood (transudate). This information is helpful in guiding treatment.
The article on Body Fluid Analysis lists some fluids other than blood that may be evaluated with an LD test.

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When is it ordered?
Blood test
An LD level may be ordered, along with other tests such as a comprehensive metabolic panel (CMP), when a health practitioner suspects that a disease or condition is causing some degree of cellular or tissue damage. If LD is elevated, then more specific tests, such as ALT, AST or ALP, may help diagnose the condition and help determine which organs are involved. Once the acute or chronic problem is diagnosed, total LD levels may be ordered at regular intervals to monitor its progress and/or resolution.

LD levels may also occasionally be ordered when an individual has experienced muscle trauma or injury or when a person has signs and symptoms of hemolytic anemia.

LD testing may be ordered on a regular basis when an individual has been diagnosed with cancer.

Body fluid test
This test may be ordered, for example, when a person has signs and symptoms of meningitis or when someone has a buildup of fluid around the heart, lungs or in the abdomen.

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What does the test result mean?
Looking for reference ranges?

Blood test
Elevated levels of LD usually indicate some type of tissue damage. LD levels typically will rise as the cellular destruction begins, peak after some time period, and then begin to fall. LD levels are elevated in a wide variety of conditions, reflecting its widespread tissue distribution.

An elevated level of LD may be seen with:

Hemolytic anemia
Pernicious anemia (megaloblastic anemia)
Infections such as infectious mononucleosis (mono), meningitis, encephalitis, HIV
Sepsis
Intestinal and lung (pulmonary) infarction
Acute kidney disease
Acute liver disease
Acute muscle injury
Pancreatitis
Bone fractures
Testicular cancer, lymphoma or other cancers
A high LD in the blood may indicate that treatment for cancer (e.g., chemotherapy) has not been successful. A high level is predictive of a poorer outlook for survival for those with cancer. With some chronic and progressive conditions, moderately elevated LD blood levels may persist. Low and normal levels of LD do not usually indicate a problem. Low levels are sometimes seen when someone ingests large amounts of ascorbic acid (vitamin C).

Body fluids:

Cerebrospinal fluid—a high LD indicates that meningitis is likely caused by bacteria, while a low or normal level indicates viral meningitis is more likely.
A high LD indicates that pericardial fluid, peritoneal or pleural fluid is an exudate, while a low level indicates it is transudate. Transudates are usually caused by congestive heart failure or cirrhosis. Exudates have several possible causes and usually require additional testing to determine the cause. Read more about these tests by accessing the specific fluid article listed under Related Tests (above).
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Is there anything else I should know?
Many things can affect LD results that are not necessarily a cause for concern. For example:

Strenuous exercise can cause temporary elevations in LD.
Hemolysis of the blood specimen can cause falsely elevated results. This may happen if the specimen is handled roughly, stored in extreme temperatures, or if the sample was difficult to collect.
If a person's platelet count is increased, serum LD can be artificially high and not reflective of the LD actually present in the circulation.
Historically, the LD test was used to help diagnose and monitor a heart attack, but the test for troponin has largely replaced LD in this role. LD is not specific for damage to the heart and is no longer recommended for evaluating people with suspected acute coronary syndrome (ACS).

[Lynn K]

Also from WebMd

Elevated blood LDH doesn’t always signal a problem. It might be the result of strenuous exercise. The level may also be high if your blood sample is handled roughly in the lab or not stored at the proper temperature. Sometimes, taking too much vitamin C can be to blame. Finally, your blood LDH might be high if your platelet count is higher than normal.

[strangerbynight]

I do excercise but not crazy, only 40 minutes treadmill a day, but I do have a shoulder pain that come and go.

[Lynn K]

Try not to worry too much about this. Your doctor is aware of your test result and from what you said they don’t seem to be concerned. As I found there are many reasons for your elevated result several are beguine including over worked muscles. I found this on healthline:

“Certain medications and drugs may interfere with an accurate LDH test. Large amounts of vitamin C (ascorbic acid) may lower LDH levels. Alcohol, anesthetics, aspirin, narcotics, and procainamide may raise LDH levels. Strenuous exercise may also raise LDH levels. Ask your doctor about any medications you should avoid before the test.”

Even damage to your blood test sample like by accidental agitation of the sample can cause a falsely elevated result.

Your result was not very elevated. You should ask your doctor to provide an explanation about this result so you can know more about what is going on and his plan about this result to know his thoughts about your LDH and hopefully ease your mind

My Hepatologist at the University of Washington liver center has never tested me for LDH even though I have had hep c for decades and liver cirrhosis for 10 years.

Do you have an elevated platelet count? Are you anemic (low red blood cell count)? Either of those can cause a increase in LDH from what I am reading. This one LDH test alone is not informative alone and needs additional testing to find the root cause because LDH can be associated with many different things.

Have you had a Fibroscan test to determine if you have liver damage? How long do you think you had hep c?

I am kinda curious to hear what your doctor thinks about the meaning for this test.

[strangerbynight]

He only told me that this is my liver enzymes which is not completely true, i mean he can see all others liver enzymes are in normal range, like ALT, AST, GGT, CK, all my test are within normal limit, my platelet are in normal range, everything except this LDH level, i read that there are 5 subtype for this elevated enzymes test, why didnt he order the test to narrow down to find out which organs is damage, i wish i know what this LDH means when i was at the office today, did not know until i went home and did some google search, my fibroscan before treatment was F0-1, ct scan and ultrasound are good, i have look at all my previous blood test and i have never seen the LDH in the test, this is the first one, i came to see him because i have been having some unsual shape of my stools, (flat) thats when he ordered these test..

[Lynn K]

I just googled still shape flat are your like a ribbon?

“Flat stool. The changes in the stools' shape and texture are most commonly related to the diet. ... The so-called ribbon feces could be due to a mass present in the colon or in the rectum that limits the size of the stool. This could also be a sign of colorectal polyps and cancer.“

Sounds like a colonoscopy might be a good test but that is of course up to your doctor. Does he intend to do any additional testing?

Yeah I saw that about the sub types and also that this test was formerly used, along with other uses, to diagnose a prior recent heart attack but another test is now used for this purpose.

Anyway as your liver is healthy and your other liver enzymes are normal I tend to doubt this LDH test has anything to do with your liver or your treatment.

Hopefully your doctor will work to figure out if this test is signifigant and to determine the cause..

[strangerbynight]

The flat stools part doesn't bother me no more since i have increase all bran bud fibers and it seems to go away most the time now, yes next week i will have a colonscopy to find out if theres any polyps or any unsual things, yes this LDH things driving me to the roof, last week i went to er because i had a bit of hard time to breath but after x-ray, bood test and EKG they found nothing wrong with me, i am better now, anyone had this kind of elevated LDH please tell me what you think it is..

[Lynn K]

Since it could be so many different things I would think even if someone here in the forum also experienced slightly elevated LDH it make it may not be related to what is causing your increase.

But hope if there is someone here they can share their experience. I still feel your best bet is to ask your doctor what they feel might be the cause in your case.

Please let us know what you find out.

[strangerbynight]

I went to another doctor and he told me the test is non specific find and he said its only mild elevated, i also talk to another hepatologist and he said same thing, he said that i should go have another test once i am svr12, he said its very common to see this LDH elevated in patient with hep c, he also said that about 5% of normal population have this above normal, but what really bug me is that all my other liver enzymes are in normal range and so why its only this LDH is elevated? My CK is fine too,, he also said this LDH fall slowest, i hope there will be no other tissue damage, i just dont understand why my doctor have this LDH test anyways, never done it before.

[Lynn K]

 I guess the only way to find out why he did this test when he never did it before is to ask.

[strangerbynight]

I guess the only way to find out why he did this test when he never did it before is to ask.

All he said was it was my liver enzymes and it could the time of the day that cause elevated, i never ask him why he want that in the test because i didnt know whats that enzymes at the time un til doctor google told me a bunch of no so good find..

[Lynn K]

Yeah my doctor only does a hepatic function panel that has the common liver enzyme tests we all usually have ALT, AST, ALP, bilirubin and albumin. I think to have the LDH test you did it is had to be specifically asked for and would be a separate test result not a part of the standard liver panel.

Per WebMd:

“The lactate dehydrogenase (LDH) test looks for signs of damage to the body's tissues. LDH is an enzyme found in almost every cell of your body, including your blood, muscles, brain, kidneys, and pancreas.”

So it is not an enzyme specific just to the liver.

But yeah all body enzymes vary all the time and like I assumed and your doctor confirmed it is not very elevated and only slightly above normal. If they had not tested before it is possible this could be a normal result for you as your doctor has said.

Ok CK kinda threw me that test is called Creatine kinase. I have never had that one either. Creatine kinase test may be used to detect inflammation of muscles (myositis) or muscle damage due to muscle disorders (myopathies) such as muscular dystrophy or to help diagnose rhabdomyolysis if a person has signs and symptoms. So more of a muscle damage test not really a liver related test.

Your doctor may be looking for causes for other symptoms you have described to him and not related to hep c and liver disease. Either hat or your doctor has an unusual testing plan for you.

[strangerbynight]

Yeah my doctor only does a hepatic function panel that has the common liver enzyme tests we all usually have ALT, AST, ALP, bilirubin and albumin. I think to have the LDH test you did it is had to be specifically asked for and would be a separate test result not a part of the standard liver panel.

Per WebMd:

“The lactate dehydrogenase (LDH) test looks for signs of damage to the body's tissues. LDH is an enzyme found in almost every cell of your body, including your blood, muscles, brain, kidneys, and pancreas.”

So it is not an enzyme specific just to the liver.

But yeah all body enzymes vary all the time and like I assumed and your doctor confirmed it is not very elevated and only slightly above normal. If they had not tested before it is possible this could be a normal result for you as your doctor has said.

Ok CK kinda threw me that test is called Creatine kinase. I have never had that one either. Creatine kinase test may be used to detect inflammation of muscles (myositis) or muscle damage due to muscle disorders (myopathies) such as muscular dystrophy or to help diagnose rhabdomyolysis if a person has signs and symptoms. So more of a muscle damage test not really a liver related test.

Your doctor may be looking for causes for other symptoms you have described to him and not related to hep c and liver disease. Either hat or your doctor has an unusual testing plan for you.

As far as my dr google gave me, there are 5 subtype is so call isoenzymes, my doctor next step would be order this kind of test but he chose not to and i dont know why, basically the next will be to narrow down which organs or tissue is damage, i know its not my liver because all the enzymes are normal, i know its not my shoulder pain because the CK was normal range, my fear is other important organs like heart, lung, kidney, pancreas ect...its very scary find like i said, i am going to push him to do another test, i had 2 sleepless nights over this already, i feel like he torturing me now, i wish he never had this LDH on this blood test ever, i think he assume that this was elevated because of my liver or because he knows i had hep c, i am very fearful of this now..

[Lynn K]

As a couple of your doctors have said your results are only slightly elevated. It is possible it could even be normal for you.

I know it is easy to say and harder to do but try not to worry about this slightly above normal result. Your doctors are not concerned and they know more than we do.

I have only one result I am aware of that is not normal my platelet count is about 33% below minimum normal. This is because of my cirrhosis and resulting enlarged spleen. Because of this I have a symptom of bruising easily.

But even though I have symptomatic liver cirrhosis I try not to let this occupy my every waking thought. I have better things to do than dwell on my medical condition.

My suggestion is to occupy your mind with other things and do your best to put this out of your mind. At this point you don’t even know it this result means anything.

Good luck

[Jorah]

Many years of blood tests, they never tested this.

[Lynn K]

Me neither

So the only way to know why he took this test when he never did before is to ask

[strangerbynight]

Many years of blood tests, they never tested this.

Few doctors told me the test are not very useful at all, I think he might put a check mark by error, maybe he mean to test my cholesterol levels since I have gained 10 pounds..I wish he never test this at all

[Lynn K]

I can see why the test isn’t especially useful as it is so non specific to any body system.

Again try to move on and try to not dwell on this one test it means little to nothing as your doctors have said it is only slightly above normal which could be a normal result for you.

Try not to worry unless you have reason to, which right now you do not.

[strangerbynight]

I can see why the test isn’t especially useful as it is so non specific to any body system.

Again try to move on and try to not dwell on this one test it means little to nothing as your doctors have said it is only slightly above normal which could be a normal result for you.

Try not to worry unless you have reason to, which right now you do not.

Thanks Lynn, ever since i was diagnosed this hep c which was feb 2017 and my anxiety, the worry, has been terrible, this is not me at all, i am a very care free person, i dont worry of tomorrow, i think this hep c has to do with the way i am, i just cant help it but always think and i alway take the worst and apply to me, from my ultrasound where they found a lesions and now this, one thing for sure is that i am happy because i am cured now, its just mentally exhausted, i just dont know why i keep doing this, so negative about my health even thought i am physically fine, so sorry to here my whining, and thanks for listening..

[Lynn K]

Hey no worries a lot of people come here to vent. I mean who can we talk to who understand what we are going through, right?

I have had a long time to get used to all this. I learned I was infected in 1990 and diagnosed with cirrhosis in Jan 2008. I have been followed closely since I was initially diagnosed with hep c. I was told not to worry that much about hep c so I didn’t. But as the years went on and with treating several times but to no effect and with my liver getting worse and worse over time I grew more and more concerned. Finally, when I was diagnosed with cirrhosis I cried a little in my doctors office.

But fortunately you should not have to face anything like this so just hang in there. It gets better....I promise 

[strangerbynight]

Hey no worries a lot of people come here to vent. I mean who can we talk to who understand what we are going through, right?

I have had a long time to get used to all this. I learned I was infected in 1990 and diagnosed with cirrhosis in Jan 2008. I have been followed closely since I was initially diagnosed with hep c. I was told not to worry that much about hep c so I didn’t. But as the years went on and with treating several times but to no effect and with my liver getting worse and worse over time I grew more and more concerned. Finally, when I was diagnosed with cirrhosis I cried a little in my doctors office.

But fortunately you should not have to face anything like this so just hang in there. It gets better....I promise 

You are a very strong person Lynn, i came to this forum since i was diagnosed and you have answered alot of my questions, you have help me to calm down alot with my mental stage, i wish your liver will get better and better. God bless you.