rising LDH

[Mend123]

my LDH has been consistently rising since my CLL diagnosis in 2020. Past two blood draws (six months apart) it has been outside of (above) normal. But all my other numbers are steady. Been on watch and wait. But getting nervous. The doctors say they aren’t worried. My total lymphs are 8.4. LDH is 289. Any suggestions?

[cajunjeff]

Hello Mend. I am not a doctor or expert with LDH levels. I do know that ldh normal levels can vary a bit from lab to lab and that according to some labs, a reading of 289 is not that far out of normal. I have seen adult reference ranges of normal ranges from 140 to 280 for an adult. 289 is essentially juts a high normal range.

I suspect your doctors are not worried because it sounds as if your other labs are normal and that your ldh, while a tad high, is not all thta abnormal for someone with cll. It might not even be your cll that has raised your ldh. I would think your Cll would be a prime suspect for your elevated ldh though.

With all your other labs in normal ranges over 5 yrs out from your diagnosis, I imagine your doctors see you as having mostly indolent cll thus far and are not going to react much to slightly elevated ldh. Good luck.

Normal LDH ranges

For adults, normal LDH levels in the blood are usually 140–280 units per liter (U/L)Trusted Source. Doctors use a person’s symptoms to help interpret the data.

Infants and young children usually have significantly higher normal levels of LDH. For example, in newborns, it is 135–750 U/L, and in children up to 12 months, it is 180–435 U/L.

medicalnewstoday.com/articl...

*Some labs have the high end for adults in the 225 range, but even so I would not think 289 is that far out of normal for someone who does have cll.

[Mend123 in reply to cajunjeff]

Thank you!

[DoNorth]

LDH should rise with increasing lymphocytes. This is completely normal and expected with progressive CLL

[Mend123 in reply to DoNorth]

Except my lymphocytes have decreased not increased. Which is weird

[AussieNeil Partner Administrator in reply to Mend123]

Chris Dwyer (CLLCanada healthunlocked.com/user/CLL... ) said it well in a reply to another forum back in 2011, before this community was established.

"LDH (LD) is often used as a marker of tissue breakdown as LDH is abundant in red blood cells and can function as a marker for rupturing of red blood cells.

However, a blood sample that has been handled incorrectly can show false-positively high levels of LDH due to cell damage.

It sometimes is an indication of a heart attack or trauma like a car accident etc.

Disorders indicated by elevated LDH include cancer, meningitis, encephalitis, acute pancreatitis, and HIV

It is considered with other factors as a marker of disease progression in CLL."

So there are other factors besides CLL that can influence LDH. In my experience, my very highest LDH results have correlated with poor blood sample taking or transport. When the phlebotomist has trouble getting a good flow, that can cause more blood cells to be broken, releasing the intracellular LDH into the blood plasma. If you have a high lymphocyte count and have lots of smudge cells (ruptured CLL cells), that's going to boost LDH too.

As to why your LDH can fall when your lymphocyte count has decreased, the increase in LDH with CLL progression is going to be due to both the total CLL tumour throughout your body as well as the rate at which your CLL cells are dying and thereby releasing their intracellular LDH, so that it eventually finds its way into your blood from your spleen, nodes and bone marrrow. We know from heavy water studies that CLL cells are not immortal. In general, they just die more slowly than they clone and sometimes spontaneous remission/regression can occur.

Neil

[Mend123 in reply to AussieNeil]

Thank you Neil!

[mondaysmail]

Good morning. Your age? Pre or post menopause? As your estrogen level decreases your cholesterol values will rise. What are your total and HDL cholesterol values? LDL at 289 should be explored carefully.

[Mend123 in reply to mondaysmail]

LDH not LDL

[mondaysmail in reply to Mend123]

Ouch. Apologies all. Cardiac surgery for me this month; no excuse.

[CoachVera55 in reply to mondaysmail]

Good Luck with that 👍🏾