Study of serum lactate dehydrogenase level as diagnostic and prognostic indicator of megaloblastic anemia

Authors

  • Neelendra Chakravarty Department of Pathology, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
  • D. Santhikiran Department of Pathology, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
  • Anupam Brahma Department of Pathology, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
  • U. R. Singh Department of Pathology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India
  • P. C. Kol Department of Pathology, Shyam Shah Medical College, Rewa, Madhya Pradesh, India
  • Sukanta Sen Department of Pharmacology, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India http://orcid.org/0000-0002-8348-0251

DOI:

https://doi.org/10.18203/2349-3933.ijam20193271

Keywords:

Central India, Dehydrogenase, Hemoglobin, Megaloblastic anaemia, Serum lactate

Abstract

Background: Megaloblastic anaemia is the hematologic manifestation of faulty proliferation of blood cell precursors. The present study was done to facilitate the diagnosis prior to performing any bone marrow aspirate by estimation of the value of serum LDH in the diagnosis of megaloblastic anaemia.

Methods: The cases were selected from patients attended the OPD and admitted in Sanjay Gandhi Memorial Hospital & Gandhi Memorial Hospital, Shyam Shah Medical College, Rewa, Madhya Pradesh. Following investigations were then done to classify anaemia and to establish the diagnosis of megaloblastic anaemia like Haemoglobin estimation by cyanmethaemoglobin method, PCV, RBC count and absolute values, general blood picture, reticulocyte count, bone marrow examination and serum LDH estimation before and after treatment.

Results: Of the 100 cases, 50 cases (50%) of the cases were microcytic hypochromic anaemia. 15 cases (15%) were normocytic normochromic anaemia; 35 cases (35%) were macrocytic anaemia on the basis of general blood picture and absolute values. The incidence of megaloblastic anaemia in Indian adults was 20%. Maximum number of cases (90%) of the cases had serum LDH level of more than 1000 U/L. Range of serum LDH level was 520 U/L to 4520 U/L. Thus, there was 2 to 20-fold of highest reference value (240 U/L at37 C) rise in serum LDH level in megaloblastic anaemia.

Conclusions: Megaloblasatic anaemia is not uncommon in Indian adults and serum LDH levels provide an important means of diagnosis. It is a non-invasive procedure, safe, and does not require any expertise.

References

Beck WS. The metabolic functions of vitamin B12. N Engl J Med. 1962;266(16):708-14.

Chanarin I, Deacon R, Perry J. Lumb M. How vitamin B12 acts. Brit J Haematol. 1981;47(4):487-91.

Castle WB. Current concepts of pernicious anaemia. Am J Med. 1970;48:541-48.

Linman JW. Vit B12 and folate deficiency anaemias (Megaloblastic anaemias): Haematology, Physiologic, Pathophysiologic and clinical principles. MacMillan Publishing Co. Inc New York; 1975: 359-60.

Baker SJ, Demoeyer EM. Nutritional anaemia, its understanding and control with special reference to the work of WHO. Am J Clin Nutr. 1979;32(2):368-408.

Herbert V. Megaloblastic anaemias. Lab Invest. 1985;52(1):3-19.

Lee GR. Megaloblastic and Non-Megaloblastic macrocytic anemias. Wintrobe’s Clinical Hematology, Lea & Febiger Phiedelphia. London. 1993;1(9):745-80.

DeGruchy GC. The red cell and anaemia: Chemical Haematology In: Medical Practice: Firkin F, Chesterman C, Penington D, Rush B (eds) 5th Ed: Oxford University Press, Delhi; 1994: 25.

Jandl JH. Megaloblastic Anemias. Blod Test-Bood of Haematolgy, 2nd Ed. Little Brown and Company, Boston, New York, Toronto London; 1996: 251-280.

Libnoch JA, Yakulis VJ and Heller P. Lactate dehydrogenase in megaloblastic none marrow. Am J Clin Patho. 1966;45(3):302-5.

Amelung D. Serum enzyme determinations in pernicious anemia [Article in German]. Dtsch Med Wochenschr. 1960 Sep 9;85:1629-32.

Wroblewski F, Gregory KF. Lactic dehydrogenase isoenzymes and their distribution in normal tissues and plasma and in disease states. Ann N Y Acad Sci. 1961;94:912-32.

Dacie JV, Lewis SM. Basic hematological techniques In: Practical Haematology, 10th Ed. Churchill Livingstone, Edinburgh, London, Melborne and New York; 2006; 26-30.

Raphael SS. Basic Hematologic Techniques In: Lynch’s Medical Laboratory Technology, 3rd Ed, Wb Saunder’s Company, Philedelphia, London, Toronto; 1976: 1073-1129.

Lakhotia M, Shah PKD, Balani V, Gupta A, Saxena A, Sinha HV. Incidence of megaloblastic anemia in Indian adults and the role of serum LDH as a diagnostic tool Indian J Haematol Blood Trans. 1994;12:113-5.

Mukiibi JM, Makumbi FA, Gwanzura C. Megaloblastic anemia in Zimbabwe: Spectrum of clinical and hematological manifestations. East Afr Med J. 1992;69(2):83-7.

Babior BM, Bunn HFB. Megaloblastic anemias. In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL, eds. Harrison’s Principles of Internal Medicine, 13th Ed. McGraw Hill Inc. New York, St. Louis, San Franciso, Tokyo, Toronto; 1994: 1726.

Lee GR, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM. Shirley Parker Levine- Megaloblastic anaemia. In: Lipincott Wlliams and Wilkins,eds. Wintrobe’s Clin Haematol. Vol. 2, 10th ed. Philadelphia;1999:1579-82.

Hallberg L. Blood volume, hemolysis and regeneration of blood in pernicious anemia; studies based on the endogenous formation of carbon monoxide and determinations of the total amount of hemoglobin. Scand J Clin Lab Invest. 1955;7(16):1-127.

Hall CA. Vitamin B12 deficiency and early rise in mean corpuscular volume. JAMA. 1981 20;245(11):1144-6.

Wilkinson J. Megalocytic anaemias. Lancet. 1949;253(6548):336-40.

Lindenbaum J, Nath BJ. Megaloblastic anaemia and neutrophil hypersegmentation. Brit J Haem. 1980;44(3);511.

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

Zimmerman HJ, West M and Heller P. Serum enzymes in disease-II lactic dehydrogenase and glutamic oxaloacetic transaminase in anemia. AMA Arch Int Med. 1958;102(1):115-123.

Heller H, Hollmann W, Knapp A. Iron deficiency anemia in young women. Z Gesamte Inn Med. 1959;14:1105-8.

Gordin R, Enari TM. Lactic acid dehydrogenase in megaloblastic anaemia. The effect of corticosteroid therapy. Acta Haematol. 1959;21(6):360-5.

Levitan R, Wasserman LR, Wroblewski E. Clinical significance of serum enzyme alteration in hematologic diseases. Clin Res. 1959;7:217.

Amelung D. Serum ferment bestimmungen bei pernizioser Anamic Serum enzyme determinations in pernicious anemia. Dtsch Med Wochenschr. 1960 Sep 9;85:1629-32.

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(1):29-36.

Elliot BA, Wilkinson JH. The serum alpha- hydroxybutyrate dehydrogenase in diseases other than myocardial infarction. Clin Sci. 1963;24:343-55.

Goldfarb TG, Papp BJ. Excessively high levels of lactic acid dehydrogenase activity in pernicious anemia. Am J Med. 1963;34(4):578-82.

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

Winston RM, Warburton FG, Scott A. Enzymatic diagnosis of megaloblatic anemia. Brit J Haematol. 1970;19(5):587.

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

Eivazi-Ziaei J, Dastgiri S, Sanaat Z. Estimation of the diagnostic value of myeloperoxidase index and lactate dehydrogenase in megaloblastic anaemia. J Clin Diagn Res. 2007;1(5):380-4.

Downloads

Published

2019-07-24

Issue

Section

Original Research Articles