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Liver

LDH value in anaemia, red blood cell breakdown and pregnancy

LDH is an enzyme, a protein that speeds up the conversion of lactate in cells. It sits in most tissues and in high concentration in red blood cells: according to Star-SHL, the LDH concentration in them is about 50 times higher than in serum, the fluid of clotted blood.

When red blood cells break down, or another tissue is damaged, LDH enters the blood and the value rises. Only a blood test shows whether that is so.

The Star-SHL normal range is 118 to 251 U/l (units per litre) in women aged 19 up to and including 50, equal to the one in men. Phillips and Henderson (2018) describe that when red blood cells break down in the body, LDH rises and haptoglobin, which binds free haemoglobin, falls.

Doctor's Assessment Included

LDH is an enzyme that enters the blood when cells break down. For adults up to 50, the upper limit at the four laboratories lies between 247 and 251 U/l.

  • A raised value points to tissue damage but not to which tissue; other tests give that answer faster.
  • Blood damaged in the tube gives a falsely high result.
  • The limit is higher in older adults: Star-SHL uses 301 U/l from age 81.

Reference Ranges

See the value that applies to you:

Choose male or female — this range differs by sex.

Enter your age — this range changes with age.

This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Your reference range
u/l
116 313 u/l
Reference ranges by group, in u/l
Female · 6–12 years 148–313 u/l
148 313
Female · 13–18 years 116–234 u/l
116 234
Everyone · 19–50 years 118–251 u/l
118 251
Everyone · 51–65 years 128–274 u/l
128 274
Everyone · 66–80 years 130–282 u/l
130 282
Everyone · 81 years and older 136–301 u/l
136 301
116 313 u/l

Source: NVKC Reference population: Dutch general-practice population (NUMBER, n = 7,574,327)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

LDH (Lactate Dehydrogenase): what Dutch laboratories use

Reference ranges by group, in u/l
Star-shl · Female · 19–50 years 118–251 U/l
118 251
Star-shl · Female · 51–65 years 128–274 U/l
128 274
Star-shl · Female · 66–80 years 130–282 U/l
130 282
Star-shl · Female · 81–120 years 130–301 U/l
130 301
Unilabs · Everyone · 19–50 years · a limit, not a range < 251 U/l
251
Unilabs · Everyone · 51–65 years · a limit, not a range < 274 U/l
274
Unilabs · Everyone · 66–80 years · a limit, not a range < 282 U/l
282
Unilabs · Everyone · 81 years and older · a limit, not a range < 301 U/l
301
Certe · Female · 18 years and older · a limit, not a range < 248 U/L
248
Diagnostiek voor U · Female · 13 years and older · a limit, not a range < 247 U/L
247
0 331.1 u/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

LDH (Lactate Dehydrogenase): what this test measures

For LDH the result gives the enzyme activity in units per litre (U/l); LD and LDH are names for the same test.

Of the five forms of the enzyme, LD1 and LD2 sit mainly in red blood cells and heart muscle, but the ordinary test adds all forms together. That is why the number cannot say by itself whether the LDH comes from red blood cells.

Haptoglobin can help with that, a protein that binds released haemoglobin and, according to Phillips and Henderson (2018), falls when red blood cells break down in the body. The indirect bilirubin and the reticulocytes help too: indirect bilirubin is a breakdown product of haemoglobin, and reticulocytes are young red blood cells.

LDH (Lactate Dehydrogenase): why this value matters

In anaemia, LDH is one of the values that show whether red blood cells are breaking down in the body, which is called haemolysis; the LDH then comes from the broken red blood cells.

In a vitamin B12 deficiency, too, LDH can rise and haptoglobin, a protein that binds released haemoglobin, fall. With such a deficiency, precursors of red blood cells already die off in the bone marrow, and that makes the picture resemble haemolysis.

LDH (Lactate Dehydrogenase): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

LDH (Lactate Dehydrogenase): how to prepare

  1. No hard training beforehand

    Required

    No heavy training, long endurance sessions or anything that leaves you out of breath in the 48 hours before the draw. Normal walking is fine.

  • Water is always fine. Drink as usual beforehand, it makes the draw easier.
  • Take your usual medication, unless your own doctor told you otherwise.

LDH (Lactate Dehydrogenase): when is testing worthwhile?

LDH is measured in the work-up of some forms of anaemia, together with other values that show whether red blood cells are breaking down.

LDH (Lactate Dehydrogenase): symptoms of a high or low value

Low Levels

A low LDH value gets no explanation from the Dutch society for clinical chemistry (NVKC), because its explanation only deals with raised values. Star-SHL gives women and men the same lower limit in every adult age group, for example 118 U/l in the band from 19 up to and including 50.

High Levels

A raised LDH indicates, according to the Dutch society for clinical chemistry (NVKC), that cells have broken down, and broken red blood cells count among them. Which tissue the LDH comes from does not show in the value itself; for red blood cells, haptoglobin and the blood count help to judge that.

With pre-eclampsia, a raised LDH can be part of HELLP syndrome, a rare, severe form.

Thuisarts, the Dutch GPs' patient website, advises calling the midwife or gynaecologist with pre-eclampsia for symptoms such as a headache, nausea or vomiting, blurred vision or flashes of light. Thuisarts also names pain in the upper abdomen or back, a tight band feeling around the abdomen, a swollen face and thick ankles, and twitching. The full list is on Thuisarts itself.

LDH (Lactate Dehydrogenase): causes of a low or high value

What raises the value

  • Tissue damage

    LDH sits in most tissues and enters the blood when cells break down, so any disease that damages a tissue or organ can raise the value.

  • Heart attack

    After a heart attack LDH can rise, but troponin and CK become measurable in the blood sooner after a heart attack.

  • Breakdown of red blood cells in the body (haemolysis)

    When red blood cells break down in the body, their LDH is released into the blood.

  • Internal bleeding

    LDH can be raised after bleeding inside the body.

  • Burst red blood cells in the tube

    The LDH concentration in a red blood cell is about 50 times higher than in serum, so blood damaged in the tube gives a falsely high result.

LDH (Lactate Dehydrogenase): lifestyle and this value

With a raised LDH and anaemia, it makes sense to have haptoglobin, the reticulocytes (young red blood cells) and vitamin B12 looked at.

LDH (Lactate Dehydrogenase): frequently asked questions

Is there a separate LDH limit for women?

Star-SHL and Unilabs do not use a separate LDH limit for adult women. Star-SHL uses the same values for women and men from age 19, such as 118 to 251 U/l between 19 and 50. Diagnostiek voor U states, above age 12, an upper limit of 247 U/l for women and 248 U/l for men.

What does LDH have to do with HELLP syndrome?

In HELLP syndrome, a rare, severe form of pre-eclampsia in which red blood cells break down, a low ratio between LDH and the enzyme AST can help doctors tell the syndrome apart from related conditions. That is stated in an article by Phillips and Henderson in American Family Physician (2018).

Why is haptoglobin measured next to LDH?

Haptoglobin is measured next to LDH because this protein binds released haemoglobin and falls when red blood cells break down in the body. According to a 2005 article by Tefferi and colleagues, a low haptoglobin together with a raised LDH generally suggests haemolysis. Next to a raised indirect bilirubin (a breakdown product of haemoglobin) or next to more reticulocytes (young red blood cells), a low haptoglobin points that way too.

LDH (Lactate Dehydrogenase): sources

  1. den Elzen WPJ, Brouwer N, Thelen MH, Le Cessie S, Haagen I-A, Cobbaert CM. NUMBER: standardized reference intervals in the Netherlands using a 'big data' approach. Clin Chem Lab Med 2018;57(1):42-56. (retrieved 2026) doi.org
  2. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  3. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  4. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  5. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  6. NVKC, Alles over testen: LDH, allesovertesten.nl, geraadpleegd 2026-10-07 (retrieved 2026) allesovertesten.nl
  7. Star-SHL, Labbepalingen: LD(H), star-shl.nl, geraadpleegd 2026-10-07 (retrieved 2026) star-shl.nl

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LDH (Lactate Dehydrogenase)

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