In this paper, an ultrasound-assisted headspace liquid-phase microextraction with in-drop derivatization was developed for the extraction and determination of hexanal and heptanal as the biomarkers in human blood. In the method, a polychloroprene rubber (PCR) tube was utilized as container to load extraction solvent (methyl cyanide) and derivatization reagent (2,4-dinitrophenylhydrazine, 2,4-DNPH). Volatile aldehydes were headspace extracted and simultaneously derivatized in the droplet, followed by LC-UV detection of the formed hydrazones. The stability of organic solvent and the sensitivity of the method enhanced greatly. Under the optimal conditions, good linearity was obtained in the concentration range of 0.01–10 μmol L−1 (r > 0.997) and the limits of detection (LOD) for hexanal and heptanal were 0.79 and 0.80 nmol L−1, respectively. The recoveries in blood sample ranged from 75.2% to 101.1% with the inter- and intra-day precisions less than 9.8%. The method possesses the advantages such as simplicity, sensitivity, efficiency, low consumption of solvent, and little interference from sample matrix. It provides great potential for the investigation of volatile disease biomarkers (aldehydes) in complex biological samples.