High LDH and transaminases

Hi everyone,

I am a 26 year old male with a history of mild arrhythmia. 2 months ago I complained to my cardiologist of stomach acidity and pain in my RUQ. He ordered an ultrasound and my liver turned out fatty. I then went to see a gastroenterologist who had all possible liver tests run. They came back normal (maybe upper range fro transaminases).

He was not concerned and I went back to my normal life with Nexium.  I actually had had elevated transaminases in the past, going back to normal (a few years ago, found out while donating blood, or having a general checKup), but doctors had never been concerned.

For the past 3 weeks I have been quite tired (it happens to me some times) and the whole thing culminated in a bad cold, with low grade fever last week. During that last week, I had my liver enzymes tested again, and here are the numbers:

SGOT 65 (normal 0-40 U/L)
SGPT 81 (normal 0-40 U/L)
LDH 1440 (normal 100-250)

so it turns out my transaminases are elevated, and my LDH is 10 times what it should be. The rest is normal. By the way, those blood tests were after lunch.

Do you have any idea as to what might be going on? I am very worried right now as I know some of those values could go with presence of a tumor...By the way my hepatitis panels are negative.

thanks for your input. Of course I will wait and follow up with my GE.

Julien

[Kevin Pho, MD]

Elevated levels of LDH and changes in the ratio of the LDH isoenzymes usually indicate some type of tissue damage. Usually LDH levels will rise as the cellular destruction begins, peak after some time period, and then begin to fall.

Elevated levels of LDH may be seen with:

* Cerebrovascular accident (CVA, stroke)
* Drugs: anesthetics, aspirin, narcotics, procainamides, alcohol
* Hemolytic anemia
* Pernicious anemias (megaloblastic anemais)
* Infectious mononucleosis (Mono)
* Intestinal and pulmonary infarction (tissue death)
* Kidney disease
* Liver disease
* Muscular dystrophy
* Pancreatitis
* Some cancers

With some chronic and progressive conditions, and some drugs, moderately elevated LDH levels may persist.

As you can see, there are a wide variety of conditions that can raise LDH.  You may want to consider tests for hemolytic anemia (breakdown of red blood cells) - this can be done via bilirubin level, haptoglobin level and reticulocyte count, as well as further evaluation of the liver - including consideration of a biopsy.  A test for mononucleosis (Epstein Barr virus) should also be done.  Also ensure that you are not taking any medications that can harm the liver.

You may want to discuss these possibilities with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[julien1977]

Thanks for the feedback.

I just received the new tests that my doctor ordered. I'll have to wait for his insight. In the meantime, if anyone has a clue as to what was going on, let me know:

LDH 255 normal 0-250, considered HIGH (although down from the 1440...)
LDH 1 24.5 normal 16-28
LDH 2 37.4 normal 29-37 HIGH
LDH 3 19 normal 17-23
LDH 4 7.2 normal 9-15 LOW
LDH 5 11.9 normal 8-20

CBC normal, sed rate normal, RF normal, Lupus panel normal, Hep panel normal. This time no transaminases were tested.

So, still a high total LDH, high LDH 2 (white blood cells?) and low LDH 4 (pancreas?).

By the way, This was concurrent with what I diagnosed as a bad cold. But I've had that kind of "cold" on and off since a trip to Peru 4 years ago where I got pneumonia after drinking (unintentionally of course) from a filthy hot spring. It was never investigated further (just monitored), but it left me weak for weeks.

Each time I get that "cold", it reactivates a spot in my lungs that make me cough and feels irritated, itchy. It always last for weeks after I recover from the "cold".

Could the LDH elevation be linked to that story, and the transaminases are high from the fatty liver (related or not)?

Could mono have been missed (they did not check because they claim I would have had very swollen lymph nodes...) what if it is not my primo-infection with mono? What about TB?

thanks for more input

Julien

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