LDH

- Lactate dehydrogenase is an enzyme that the body uses during the process of turning sugar
into energy for your cells to use.
- Lactate dehydrogenase (LD or LDH) is an enzyme involved in energy production that is found
in almost all of the body's cells, with the highest levels found in the cells of the heart, liver,
muscles, kidneys, lungs, and in blood cells; bacteria also produce LD. This test measures the
level of LD in the blood or sometimes other body fluids.
- To help detect a condition causing tissue damage, such as a blood or liver disease, and to
monitor its progress; to help stage, determine prognosis, and/or response to treatment of
certain cancers; to help evaluate body fluid (other than blood).

A lactate dehydrogenase (LD or LDH) test is a non-specific test that may be used in the evaluation of
a number of diseases and conditions. LD is an enzyme that is found in almost all of the body's cells
(as well as in bacteria) and is released from cells into the fluid portion of blood (serum or plasma)
when cells are damaged or destroyed. Thus, the blood level of LD is a general indicator of tissue and
cellular damage. The level of LD may also rise in other types of body fluids (e.g., cerebrospinal
fluid, pleural fluid, etc.) in the presence of certain diseases.

An LD blood test may be used:

 As a general indicator of the existence and severity of acute or chronic tissue damage
 To detect and monitor progressive conditions such as anemia, including hemolytic anemia
and megaoloblastic anemia, or severe infections
 To help stage, determine prognosis, and/or monitor treatment (i.e., chemotherapy) of
cancers, such as germ cell tumors (e.g., some types of testicular cancer and ovarian
cancer), lymphoma, leukemia, melanoma, and neuroblastoma

An LD test is performed on body fluids for a few different reasons:

 To help evaluate cerebrospinal fluid and distinguish between bacterial or viral meningitis
 To evaluate other body fluids such as pleural, peritoneal or pericardial fluid and help
determine whether the accumulation of fluid is due to injury and inflammation (exudate) or
due to an imbalance of pressure within blood vessels and the amount of protein in the blood
(transudate). This information is helpful in guiding treatment.

The article on Body Fluid Analysis lists some fluids other than blood that may be evaluated with an
LD test.

Blood test
An LD level may be ordered, along with other tests such as a comprehensive metabolic panel (CMP),
when a health practitioner suspects that a disease or condition is causing some degree of cellular or
tissue damage. If LD is elevated, then more specific tests, such as ALT, AST or ALP, may help diagnose
the condition and help determine which organs are involved. Once the acute or chronic problem is
diagnosed, total LD levels may be ordered at regular intervals to monitor its progress and/or
resolution.

LD levels may also occasionally be ordered when an individual has experienced muscle trauma or
injury or when a person has signs and symptoms of hemolytic anemia.
LD testing may be ordered on a regular basis when an individual has been diagnosed with cancer.

Body fluid test

This test may be ordered, for example, when a person has signs and symptoms of meningitis or
when someone has a buildup of fluid around the heart, lungs or in the abdomen.

Blood test
Elevated levels of LD usually indicate some type of tissue damage. LD levels typically will rise as the
cellular destruction begins, peak after some time period, and then begin to fall. LD levels are
elevated in a wide variety of conditions, reflecting its widespread tissue distribution.

An elevated level of LD may be seen with:

 Hemolytic anemia
 Pernicious anemia (megaloblastic anemia)
 Infections such as infectious mononucleosis (mono), meningitis, encephalitis, HIV
 Sepsis
 Intestinal and lung (pulmonary) infarction
 Acute kidney disease
 Acute liver disease
 Acute muscle injury
 Pancreatitis
 Bone fractures
 Testicular cancer, lymphoma or other cancers

A high LD in the blood may indicate that treatment for cancer (e.g., chemotherapy) has not been
successful. A high level is predictive of a poorer outlook for survival for those with cancer. With
some chronic and progressive conditions, moderately elevated LD blood levels may persist. Low and
normal levels of LD do not usually indicate a problem. Low levels are sometimes seen when
someone ingests large amounts of ascorbic acid (vitamin C).

Body fluids:

 Cerebrospinal fluid—a high LD indicates that meningitis is likely caused by bacteria, while a
low or normal level indicates viralmeningitis is more likely.
 A high LD indicates that pericardial fluid, peritoneal or pleural fluid is an exudate, while a low
level indicates it is transudate. Transudates are usually caused by congestive heart
failure or cirrhosis. Exudates have several possible causes and usually require additional
testing to determine the cause. Read more about these tests by accessing the specific fluid
article listed under Related Tests (above).

Many things can affect LD results that are not necessarily a cause for concern. For example:

 Strenuous exercise can cause temporary elevations in LD.

 Hemolysis of the blood specimen can cause falsely elevated results. This may happen if the
specimen is handled roughly, stored in extreme temperatures, or if the sample was difficult
to collect.
 If a person's platelet count is increased, serum LD can be artificially high and not reflective of
the LD actually present in the circulation.
 Historically, the LD test was used to help diagnose and monitor a heart attack, but the test
for troponin has largely replaced LD in this role. LD is not specific for damage to the heart and is no
longer recommended for evaluating people with suspected acute coronary syndrome (ACS).

Folic acid (Folate - Vitamin B-9)

The following doses have been studied in scientific research:

BY MOUTH:
 For folic acid deficiency: the typical dose is 250-1000 mcg (micrograms) per day.
 For preventing neural tube defects: at least 400 mcg of folic acid per day from supplements or
fortified food should be taken by women capable of becoming pregnant and continued through
the first month of pregnancy. Women with a history of previous pregnancy complicated by such
neural tube defects usually take 4 mg per day beginning one month before and continuing for
three months after conception.
 For reducing colon cancer risk: 400 mcg per day.
 For treating high levels of homocysteine in the blood:
o 0.5-5 mg (milligrams)/day has been used, although 0.8-1 mg/day is appears to be more
effective.
o In people with end-stage renal disease, high homocysteine levels may be more difficult to
treat, and doses of 0.8-15 mg/day have been used. Other dosage plans such as 2.5-5 mg 3
times weekly have also been used. Doses higher than 15 mg daily do not seem to be more
effective.
 For improving the response to medications for depression: 200-500 mcg daily has been used.
 For vitiligo: 5 mg is typically taken twice daily.
 For reduction of toxicity associated with methotrexate therapy for rheumatoid arthritis (RA) or
psoriasis: 1 mg/day is probably enough, but up to 5 mg/day may be used.
 For preventing macular degeneration: folic acid 2.5 mg, vitamin B12 (cyanocobalamin) 1000 mcg,
and vitamin B6 (pyridoxine) 50 mg daily.
The adequate intakes (AI) for infants are 65 mcg for infants 0-6 months and 80 mcg for infants 7-12
months of age. The recommended dietary allowances (RDAs) for folate in DFE, including both food
folate and folic acid from fortified foods and supplements are: Children 1-3 years, 150 mcg; Children
4-8 years, 200 mcg; Children 9-13 years, 300 mcg; Adults over 13 years, 400 mcg; Pregnant women
600 mcg; and breast-feeding women, 500 mcg. The tolerable upper intake levels (UL) of folate are
300 mcg for children 1-3 years of age, 400 mcg for children 4-8 years, 600 mcg for children 9-13
years, 800 mcg for adolescents 14-18 years, and 1000 mcg for everyone over 18 years of age.

Vitamin B12

Vitamin B-12 (cobalamin) is a water-soluble vitamin that plays essential roles in red blood cell
formation, cell metabolism, nerve function and the production of DNA.

Food sources of vitamin B-12 include poultry, meat, fish and dairy products. Vitamin B-12 is also
added to some foods and is available as an oral supplement. Vitamin B-12 injections or nasal spray
might be prescribed to treat vitamin B-12 deficiency.

Because your body is capable of storing several years' worth of vitamin B-12, deficiency is rare.
However, if you follow a vegetarian or vegan diet, you might be prone to deficiency because plant
foods don't contain vitamin B-12. Older adults and people with digestive tract conditions that affect
absorption of nutrients also are susceptible to vitamin B-12 deficiency.

Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal
problems, nerve damage and mood disturbances.

The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms.

How Much to Get?

The answer depends on things including your age, your eating habits and medical conditions, and what
medications you take.
The average recommended amounts, measured in micrograms (mcg), vary by age:

 Infants up to age 6 months: 0.4 mcg

 Babies age 7-12 months: 0.5 mcg
 Children age 1-3 years: 0.9 mcg
 Kids age 4-8 years: 1.2 mcg
 Children age 9-13 years: 1.8 mcg
 Teens age 14-18: 2.4 mcg (2.6 mcg per day if pregnant and 2.8 mcg per day if breastfeeding)
 Adults: 2.4 mcg (2.6 mcg per day if pregnant and 2.8 mcg per day if breastfeeding)

Food Sources of Vitamin B12

You can get vitamin B12 in animal foods, which have it naturally, or from items that have been fortified
with it.
Animal sources include dairy products, eggs, fish, meat, and poultry. If you’re looking for a food fortified
with B12, check the product’s Nutrition Facts label.

Vitamin B12 Deficiency

Most people in the U.S. get enough of this nutrient. If you’re not sure, you can ask your doctor if you
should get a blood test to check your vitamin B12 level.

With age, it can become harder to absorb this vitamin. It can also happen if you have had weight loss
surgery or another operation that removed part of your stomach, if you drink heavily, or if you’ve taken
acid-reducing medications for a long time.
You may also be more likely to develop vitamin B12 deficiency if you have:

 Atrophic gastritis, in which your stomach lining has thinned

 Pernicious anemia, which makes it hard for your body to absorb vitamin B12
 Conditions that affect your small intestine, such as Crohn's disease, celiac disease, bacterial
growth, or a parasite
 Immune system disorders, such as Graves' disease or lupus

You can also get vitamin B12 deficiency if you follow a vegan diet (meaning you don't eat any animal
products, including meat, milk, cheese, and eggs) or you are a vegetarian who doesn't eat enough eggs or
dairy products to meet your vitamin B12 needs. In both of those cases, you can add fortified foods to
your diet or take supplements to meet this need.
Pregnant or New Mom?

Are you a pregnant woman on a vegan or vegetarian diet, and plan to only breastfeed your baby? You
should talk to your doctor before you have your baby, so that you have a plan in place for how you’ll get
enough vitamin B12 to keep your baby healthy. Without enough vitamin B12, your baby could have
developmental delays and not thrive and grow like he should.

Symptoms of Vitamin B12 Deficiency

If you have vitamin B12 deficiency, you could become anemic. A mild deficiency may cause no symptoms.
But if untreated, it may lead to symptoms such as:

 Weakness, tiredness, or lightheadedness

 Heart palpitations and shortness of breath
 Pale skin
 A smooth tongue
 Constipation, diarrhea, loss of appetite, or gas
 Nerve problems like numbness or tingling, muscle weakness, and problems walking
 Vision loss
 Mental problems like depression, memory loss, or behavioral changes

- Vitamin B12 and folate deficiencies are a lack of these two B complex vitamins that the body
needs for several important functions. They are required to make normal red blood cells
(RBCs), repair tissues and cells, synthesize DNA (the genetic material in cells). B12 is also
important for normal nerve cell function. B12 and folate (also known as folic acid or vitamin
B9) are nutrients that cannot be produced in the body and must be supplied by the diet. The
body stores 3 to 6 years worth of B12 and about a 3 months' supply of folate in the liver. So
a B12 and/or folate deficiency reflects a chronic shortage of one or both of these vitamins.

Iron

How Much Iron Do You Need? How much iron you need each day depends on your age, gender, and
overall health. Infants and toddlers need more iron than adults, in general, because their bodies are
growing so quickly. In childhood, boys and girls need the same amount of iron -- 10 milligrams daily from
ages 4 to 8, and 8 mg daily from ages 9 to 13. Starting at adolescence, a woman's daily iron needs
increase. Women need more iron because they lose blood each month during their period. That's why
women from ages 19 to 50 need to get 18 mg of iron each day, while men the same age can get away
with just 8 mg. After menopause, a woman's iron needs drop as her menstrual cycle ends. After a woman
begins menopause, both men and women need the same amount of iron -- 8 mg each day.

You might need more iron, either from dietary sources or from an iron supplement, if you:

 Are pregnant or breastfeeding

 Have kidney failure (especially if you are undergoing dialysis, which can remove iron from the
body)
 Have an ulcer, which can cause blood loss
 Have a gastrointestinal disorder that prevents your body from absorbing iron normally (such
as celiac disease, Crohn's disease, or ulcerative colitis)
 Take too many antacids, which can prevent your body from absorbing iron
 Have had weight loss (bariatric) surgery
 Work out a lot (intense exercise can destroy red blood cells)
If you are a vegetarian or vegan, you may also need to take an iron supplement, because the body
doesn't absorb the type of iron found in plants as well as it absorbs the iron from meat.
WBC Morphology