Lactate Dehydrogenase Isoenzymes

Does this test have other names?

LDH, lactic dehydrogenase

What is this test?

This is a blood test to measure the different LDH isoenzymes that may be in your blood. Enzymes are proteins that cause chemical reactions in your body and provide energy. LDH enzymes are found in many tissues in the body, including the heart, red blood cells, liver, kidneys, brain, lungs, and skeletal muscles.

LDH exists in five forms, or isoenzymes. Each isoenzyme has a slightly different structure and is found in different concentrations in different tissues. For example, LDH-1 is found mostly in red blood cells and heart muscle. LDH-3 is concentrated in the lungs, although it is also found in other tissues. When LDH isoenzymes spill into your blood, it indicates damaged or diseased tissue. The results may tell your healthcare providers which tissue may be damaged or injured.

Why do I need this test?

You may need this test if your healthcare provider wants to see whether you have had a heart attack, blood disorder, or damage to your liver or other tissues.

What other tests might I have along with this test?

Your healthcare provider might order other blood tests that can detect elevated enzyme levels.

For liver enzymes:

• Aspartate aminotransferase, or AST

• Gamma-glutamyl transpeptidase

• Alkaline phosphatase

• Alanine aminotransferase, or ALT

• Leucine aminopeptidase

• 5'-nucleotidase

For heart and skeletal muscle:

• Creatine phosphokinase, or CPK

Your healthcare provider might also order a urine test for LDH.

What do my test results mean?

Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you. 

Normal results for isoenzymes are listed below.

Adult/older adults:

• LDH-1: 17% to 27%

• LDH-2: 27% to 37%

• LDH-3: 18% to 25%

• LDH-4: 3% to 8%

• LDH-5: 0% to 5%

Normal ratios are:

• LDH-1 less than LDH-2

• LDH-5 less than LDH-4

When your LDH-1 is greater than your LDH-2, it could mean that you had a heart attack in the past week. Healthcare providers refer to this as "flipped LDH" because normally your LDH-2 is higher than your LDH-1.

When your LDH-5 is greater than your LDH-4 it could mean you have damage to your liver or liver disease. This includes cirrhosis and hepatitis.

If you have two diseases that have caused more than one LDH isoenzyme to rise, one disease could hide the other.

How is this test done?

The test is done with a blood sample. A needle is used to draw blood from a vein in your arm or hand. 

Does this test pose any risks?

Having a blood test with a needle carries some risks. These include bleeding, infection, bruising, and feeling lightheaded. When the needle pricks your arm or hand, you may feel a slight sting or pain. Afterward, the site may be sore. 

What might affect my test results?

If the blood sample is contaminated by broken red blood cells, a condition called hemolysis, your LDH will be elevated.

If you exercise strenuously before the sample is taken, you could have elevated LDH-1, LDH-2, and LDH-5.

Anesthetics, aspirin, narcotics, and certain other medicines can elevate your LDH. Medicines that contain ascorbic acid (vitamin C) can decrease your LDH levels. Alcohol also can affect your LDH levels.

How do I get ready for this test?

You don't need to prepare for this test. Be sure your healthcare provider knows about all medicines, herbs, vitamins, and supplements you are taking. This includes medicines that don't need a prescription and any illicit drugs you may use.