Clinical Utility of Lactate Dehydrogenase Isoenzyme Panel

Introduction to LDH Isoenzymes

• The European Germ Cell Cancer Consensus Group explicitly states that routine determination of LDH isoenzymes is not recommended, even in cancer diagnosis where total LDH has established prognostic value 1, 2

Limited Clinical Utility of Isoenzyme Fractionation

• Total LDH is mandatory for advanced testicular germ cell tumors and serves as an important prognostic factor, but isoenzyme fractionation adds no clinical value 1, 3
• Elevated total LDH is incorporated into AJCC stage IV melanoma classification as an independent predictor of poor outcome, without need for isoenzyme analysis 4
• Total LDH helps assess tumor burden in the Revised International Staging System for multiple myeloma 6
• Total LDH is part of the tumor lysis syndrome panel in pediatric acute lymphoblastic leukemia 7

Important Considerations for LDH Measurement

• Hemolysis of blood samples can falsely elevate LDH levels, making proper specimen handling critical 5