DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20183643

Utility of serum lactate dehydrogenase in the diagnosis of megaloblastic anemia

Amrapali L. Gaikwad, D. S. Jadhav

Abstract


Background: Megaloblastc anemia corresponds to severe macrocytic anemia with hypersegmented neutrophils and very high serum Lactate Dehydrogenase (LDH). The present study was undertaken to evaluate the utility of serum LDH and chloroform inhibited serum LDH in the diagnosis of megaloblastic anemia and to observe if this can be used to differentiate megaloblastic anemia from iron deficiency anemia and hemolytic anemia.

Methods: The present study was carried out on 75 patients of anemia categorised on bone marrow examination (into megaloblastic and non-megaloblastic anaemia) to evaluate the efficacy of total serum LDH levels and LDH isoenzyme pattern in the diagnosis of megaloblastic anemia. About 25 healthy adults were taken as controls.

Results: In megaloblastic anemia, total serum LDH level was found to be increased to about nineteen folds and in hemolytic anemia it was found to increased four folds as compared to normal. On statistical analysis this increased total serum LDH level in megaloblastic anemia and hemolytic anemia as compared to control group was found to be significant.In the present study serum LDH level above 3000IU/L was associated with megaloblastic anemia and serum LDH level below 900IU/L was suggestive of iron deficiency anemia. The chloroform inhibition test was less than 25% in megaloblastic anemia and more than 25% in hemolytic anemia and these differences were found to be statistically significant (t=9.62, df=49, p<0.001).

Conclusions: Total serum LDH levels more than 3000IU/L are diagnostic of megaloblastic anemia. Reversed LDH isoenzyme pattern (LDH1>LDH2) by chloroform inhibition test is an adjuvant in the diagnosis where total serum LDH levels are between 451-3000IU/L and can also differentiate megaloblastic anemia from hemolytic anemia.


Keywords


Iron deficiency anemia, Hemolytic anemia, Megaloblastc anemia, Serum LDH

Full Text:

PDF

References


Milman N. Anemia-still a major health problem in many parts of the world. Ann Hematol. 2011;90(4):369-77.

Jaswal TS, Mehta HC, Gupta V, Singh M, Singh S. Serum lactate dehydrogenase in diagnosis of megaloblastic anemia. Indian J Pathol Microbiol. 2000;43(3):325-9.

Chaudhari S, Bindu S. Correlation of Lactate Dehydrogenase in Megaloblastic Anemia. Inter J Curr Med App Sci. 2015;9(1):28-32.

Wickramasinghe SN. Diagnosis of megaloblastic anemias. Blood Reviews. 2006;20(6):299-318.

Garba IH, Ubom GA. Total serum lactate dehydrogenase activity in acute Plasmodium falciparum malaria infection. Singapore Med J. 2005;46(11):633.

Markert CL. Lactate dehydrogenase isoenzymes: dissociation and recombination of subunits. Science. 1963;140(3573):1329-30.

Hess B, Gehm E. Lactic acid dehydrogenase in the human blood. Klin Wochenschr. 1955;33(3-4):91-3.

Eivazi ZJ, Dastgiri S, Sanaat Z. Estimation of the diagnostic value of myeloperoxidase index and lactate dehydrogenase in megaloblastic anemia. J Clin Diag Res. 2007;1(5):380-384.

Winston RM, Warburton FG, Stott A. Enzymatic diagnosis of megaloblastic anemia. Br J Haematol. 1970;19(5):587-92.

Markert CL, Moller F. Multiple forms of enzymes: Tissue, ontogenetic, and species specific patterns. Proc Natl Acad Sci, USA. 1959;45(5):753-63.

Warburton FG, Smith D. A simple method of differentiating between serum lactate dehydrogenase of cardiac origin and that derived from other tissues. Enzymologia. 1963;26:125-32.

Bates I. Reference ranges and normal values.In:Bain BJ, Bates I, Laffan MA. Dacie and Lewis Practical Haematology.12th ed,China: Elsevier; 2017:11.

Khattak AL, Hussain T, Muhammad A. Types of anemia in patients with hemoglobin less than 10g/dL. Pak Armed Forces Med J. 2007;57(1):39- 42.

Al-Ghazaly J, Al-Selwi AH, Abdullah M, Al-Jahafi AK, Al-Dubai W, Al-Hashdi A. Pattern of hematological diseases diagnosed by bone marrow examination In Yemen: A developing country experience. Clinical Lab Hematol. 2006;28:376-81.

Khanduri U, Sharma A. Megaloblastic anemia: Prevalence and causative factors. Natl Med J India. 2007;20:172-5.

Pandya HP, Patel A. Clinical profile and response in patients with megaloblastic anemia. Int J Med Sci Public Health. 2016;5:304-6.

Kaur D, Mohan G, Bhalla N. To study the clinical spectrum and haematological abnormalities in patients of macrocytic anaemia. J Evolution Med Den Sci. 2015;4(51):8900-4.

Magnani KK, Sikarwar S, Rawat N. Prevalence of megaloblastic anemia in people of Gwalior Chambal region. Inter J Med Heal Res. 2017;3(8):09-10.

Kannan A, Tilak V, Rai M, Gupta V. Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia. Int J Res Med Sci. 2016;4:2670-8.

Stein ID. Elevated serum lactate dehydrogenase activity in megaloblastic anemia-some current explanations re-examined. Am J Clin Pathol. 1973;59(1):122-3.

Gronvall C. On the serum activity of lactic acid dehydrogenase and phosphohexose isomerase in pernicious and hemolytic anemias. Scand J Clin Lab Invest. 1961;13:29-36.

Emerson PM, Wilkinson JH. Lactate dehydrogenase in the diagnosis and assessment of response to treatment of megaloblastic anaemia. Br J Hematol. 1966;12(6):678-88.

Carmel R, Barry S Serum transferrin receptor in the megaloblastic anemia of cobalamin deficiency. Eur J Haematol. 1992;49(5):246-50.