Evaluation of serum LDHlevels in the diagnosis and inmonitoring the response to the treatment in children with megaloblastic anaemia

Abstract

Background: Megaloblastic anaemia is still a common and preventable cause of anaemia in children.Invasive procedure like bone marrow examination and expensive investigation like estimation of serum vitamin B12 and folic acid levels are the definitive diagnostic tools. Their non availability at peripheral centre lead to a great deal of interest in other simple biochemical investigations like estimation of serum LDH levels. Design/methods: Children aged between 6 months to 14 yrs with clinically suspected megaloblastic anaemia formed the study group. A detailed clinical history and examination was done. All subjects had complete blood counts. Serum LDH levels, serum levels of vitamin B12 and folic acid levels were done. Serial measurements of serum LDH levels were done on day 14 and day 30 of treatment and were correlated with the haemoglobin and MCV levels. Results: A total of 48 patients formed the study group. All cases were anaemic with mean HB level of 5.25g/dl, mean MCV was 100.15fl. All cases had megaloblastic changes on peripheral smear.42 cases had low vitamin B12 levels and 6 cases had low folic acid levels. Serum LDH levels were elevated in all cases with mean level of 3423 IU/L. There was a significant negative correlation between HB levels and serum LDH levels (r = -.923, p<0.001) a significant positive correlation between MCV and serum LDH levels(r = +0.810, p<0.001). One month after treatment HB levels and MCV improved (mean HB- 10.3g/dl and mean MCV88.3fl/l). There was also a significantly fall in the serum levels of LDH 14 days and one month after treatment (p<0.001, p<0.001 respectively). Conclusion: Serum LDH levelis an important investigation in the diagnosis and in monitoring the response to treatment in megaloblastic anaemia.