Lactate Dehydrogenase Isoenzymes
Does this test have other names?
What is this test?
This is a blood test to measure the different LDH forms or isoenzymes that may be
in your blood. Enzymes are proteins that cause chemical reactions in your body and
provide energy. LDH isoenzymes are found in many tissues in the body, including the
heart, red blood cells, liver, kidneys, brain, lungs, and skeletal muscles.
LDH exists in 5 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 if you have a blood
disorder, such as anemia, or tissue damage, such as damage to your liver, heart, or
other body tissue.
What other tests might I have along with this test?
You may need other blood tests that can find elevated enzyme levels.
For liver enzymes, these tests may include:
Gamma-glutamyl transpeptidase (GGT)
For heart and skeletal muscle, tests may include:
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.
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 have anemia. Healthcare
providers refer to this as "flipped LDH" because normally your LDH-2 is higher than
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 illegal drugs you may use.