Lactate dehydrogenase (LDH) may form a macroenzyme complex which can result in an elevated serum enzyme activity. The elevated LDH activity can result in an unnecessary workup.
Mechanism: The patient has an autoantibody that binds to LDH to form a circulating complex. The complex has a longer half-life, causing accumulation.
Features of macro-LDH:
(1) The patient has an apparent elevation of serum LDH activity.
(2) No disease is identified that can explain the increase.
(3) There is evidence of an antibody (usually IgA or IgG) targeting the LDH.
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