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Ian, I’ve done some ‘routine bloods’ and…” are the words most likely to induce an elevation in my blood pressure at work. I’m not alone in detesting the taking of ‘routine bloods’ – if the test you’re doing isn’t going to change your management then don’t do it.

Equally, if you don’t know what to do with an abnormal result then you need to think hard about why you are suggesting the test. If you do enough blood tests, eventually you’ll find one that is abnormal. What then? My pet peeve for this approach is the use of LDH both in the Paediatric ED and in primary care. I’ve had plenty of discussions with anxious healthcare professional who have undertaken a ‘routine’ LDH and are now wishing they hadn’t as it is has come back as moderately raised. Ross and Abrahamson looked at this very problem and published their findings in the Archives of Disease in Childhood. Just how useful is taking an LDH in children presenting to the Paediatric ED?


The original article is here

and I have summarised it in the infographic below:



  • Ian is a Paediatric Emergency Medicine Consultant based in Derby. He loves #FOAMed, Apple products, Comics, running and his family. In that order. He dislikes cauliflower cheese.


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2 thoughts on “LDH”

  1. Tim Horeczko aka Andy Tagg Super Fan

    Interesting post and commentary — thank you!

    It is fascinating to see that every corner of the World has its “something”. Reading through this, the equivalent we have is probably the lactate — “order first, think later, panic all the time!”.

    I think most people on the US send LDH from the ED for either a) investigating suspected hemolytic anemia; or b) diagnosing pneumocystis jirovecii (carinii).

    LDH is definitely one of those labs to be thoughtful of goals and mindful of pitfalls.

    Thanks, team, for another great post!