LCHADD/TFP deficiency

Other Names

Long chain 3 hydroxyacyl-CoA dehydrogenase deficiency

LCHAD deficiency

Trifunctional protein deficiency (TFP)

Diagnosis Coding

277.85, Disorders of fatty acid oxidation

Disorder Category

A fatty acid oxidation disorder



elevated C16-OH +/- and C18:1-OH

Tested By

tandem mass spectrometry (MS/MS); sensitivity=100%; specificity=100% [Schulze: 2003]


The trifunctional protein catalyzes 3 steps in the beta-oxidation of fatty acids, including the hydratase, long-chain 3-hydroxyacyl-CoA dehydrogenase, and 3-ketoacyl-CoA thiolase activity. It is formed by two subunits encoded by two different genes (HADA and HADB) located on the same chromosome (2p23). In LCHAD deficiency, specific missense mutations within the alpha subunit (HADA) cause the disease. Mutations that completely abolish the function of the protein cause trifunctional protein deficiency. TFP deficiency can be caused either by mutations in the alpha (HADA) or beta subunit (HADB), LCHAD is caused by specific missense mutations in the alpha subunit that allow the reaction to start but not to be completed. LCHAD and TFP deficiency cause cellular damage from accumulation of 3-OH-fatty acids, impaired energy production from longer chain fatty acids, and consequent hypoglycemic crises during prolonged fasting or increased energy demands, such as fever or other stress.


about 1/250,000 live births. [Schulze: 2003] Incidence is likely higher in Finland where the carrier rate is 1:240. [LCHAD - Information for Professionals (STAR-G)]


autosomal recessive

Prenatal Testing

DNA testing in cells obtained by amniocentesis or chorionic villous sampling (CVS).

Clinical Characteristics

With treatment prior to hypoglycemic crises, intelligence is likely to be normal, though there may be progression of peripheral neuropathy and retinitis pigmentosa. Without treatment, hypoglycemic episodes may lead to developmental delay and neurologic impairment. Cardiomyopathy and/or hepatic failure may result in death. Pigmentary retinopathy develops with time. Neuropathy is significant in patients with trifunctional protein deficiency. Symptoms may begin anytime between birth and 3 years, and may be mild or severe.

Initial symptoms/signs may include:
  • poor feeding
  • vomiting
  • lethargy
  • hypotonia
  • heptomegaly
  • cardiac insufficiency
  • cardiomyopathy
  • lab findings:
    • elevated liver function tests
    • elevated CK
    • metabolic acidosis
    • lactic acidosis
    • hypoglycemia

Without effective treatment, subsequent symptoms may include:
  • hepatic disease
  • cardiomyopathy
  • cardiac conduction defects (arrhythmia)
  • peripheral neuropathy
  • pigmentary retinopathy
  • rhabdomyolysis

Follow-up Testing after Positive Screen

Quantitative plasma acylcarnitine profile, urine organic acid analysis, free 3-OH-fatty acids, biochemical and molecular genetic testing in cultured fibroblasts derived from skin biopsy or white blood cells for differentiation between LCHADD and TFP.

Primary Care Management

Upon Notification of the + Screen

  • Contact the family and evaluate the infant for heptomegaly, cardiomyopathy, family history of sudden death, maternal history of pregnancy-related liver disease (HELLP syndrome [hemolysis, elevated liver enzymes, low platelets] or ALFP [acute fatty liver of pregnancy]);
  • Provide emergency treatment/referral for symptoms of hypoglycemia, lethargy, feeding problems;
  • To confirm diagnosis, work with the following service(s): see all Newborn Screening Programs services providers (3) in our database;
  • For further advice or evaluation, consult the following service(s): Pediatric Medical Genetics , (801-213-3599); See also Services below;

If the Diagnosis is Confirmed

  • Educate the family regarding signs andsymptoms of hypoglycemia, and the need for urgent care when the infant becomes ill (see LCHADD/TFP Deficiency - Information for Parents (STAR-G) for additional information);
  • Support initiation and maintenance of avoidance of fasting, use of uncooked starch, medium chain triglycerides, and frequent, low fat, and high carbohydrate meals and snacks;
  • Oral L-carnitine (at low doses) and docosahexanoic acid (DHA)/essential fatty acids supplements may be indicated;
  • For those identified after irreversible consequences, assist in management, particularly with low vision aids, developmental and educational interventions.

Specialty Care Collaboration

Initial consultation and ongoing collaboration if the child is affected. A dietician may work with the family to devise an optimal approach to dietary management.


Information & Support

For Professionals

LCHAD - Information for Professionals (STAR-G)
Structured list of information about the condition and links to more information; Screening, Technology, and Research in Genetics.

ACT Sheet for LCHADD (ACMG) (PDF Document 333 KB)
Contains short-term recommendations for clinical follow-up of the newborn who has screened positive; American College of Medical Genetics.

Confirmatory Algorithm for LCHADD (ACMG) (PDF Document 69 KB)
Resource for clinicians to help confirm diagnosis; American College of Medical Genetics.

LCHADD Acute Illness Protocol
A guideline for healthcare professionals treating the sick infant/child who has previously been diagnosed with LCHADD; developed under the direction of Dr. Harvey Levy, Senior Associate in Medicine/Genetics at Children’s Hospital Boston, and Professor of Pediatrics at Harvard Medical School, for the New England Consortium of Metabolic Programs.

Extensive review of literature that provides technical information on genetic disorders; Online Mendelian Inheritance in Man site, hosted by Johns Hopkins University.

Genetics in Primary Care Institute (AAP)
The goal of this site is to increase collaboration in the care of children with known or suspected genetic disorders. Includes health supervision guidelines and other useful resources; a collaboration among the Health Resources & Services Administration, the Maternal and Child Health Bureau, and the American Academy of Pediatrics.

For Parents and Patients

LCHADD/TFP Deficiency - Information for Parents (STAR-G)
A fact sheet, written by a genetic counselor and reviewed by metabolic and genetic specialists, for families who have received an initial diagnosis of this newborn disorder; Screening, Technology and Research in Genetics.

LCHADD (Genetics Home Reference)
Excellent, detailed review of condition for patients and families; sponsored by the U.S. National Library of Medicine.

Trifunctional Protein Deficiency (Genetics Home Reference)
Excellent, detailed review of condition for patients and families; sponsored by the U.S. National Library of Medicine.

Fatty Oxidation Disorders (FOD) Family Support Group
Information for families about fatty acid oxidation disorders, support groups, coping, finances, and links to other sites.


Genetics-related clinical services throughout the world can be found through Genetics Clinic Directory (GeneTests).

Newborn Screening Programs

See all Newborn Screening Programs services providers (3) in our database.

Pediatric Genetics

See all Pediatric Genetics services providers (5) in our database.

For other services related to this condition, browse our Services categories or search our database.

Helpful Articles

PubMed search for LCHADD and neonatal screening, last 5 years.

Gillingham MB, Purnell JQ, Jordan J, Stadler D, Haqq AM, Harding CO.
Effects of higher dietary protein intake on energy balance and metabolic control in children with long-chain 3-hydroxy acyl-CoA dehydrogenase (LCHAD) or trifunctional protein (TFP) deficiency.
Mol Genet Metab. 2007;90(1):64-9. PubMed abstract / Full Text


Author: Nicola Longo, MD, PhD - 2/2011
Content Last Updated: 9/2010

Page Bibliography

Schulze A, Lindner M, Kohlmuller D, Olgemoller K, Mayatepek E, Hoffmann GF.
Expanded newborn screening for inborn errors of metabolism by electrospray ionization-tandem mass spectrometry: results, outcome, and implications.
Pediatrics. 2003;111(6 Pt 1):1399-406. PubMed abstract