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Test Code LCHAD SEQ LCHAD Sequencing

Clinical System Name

LCHAD/TFP Sequencing Analysis




Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency


This test is appropriate for diagnostic confirmation in symptomatic individuals who have a presumptive diagnosis of LCHAD (Long-chain 3-hydroxyacyl-CoA deficiency).


Sequencing of the HADHA and/or HADHB gene is recommended for patients with a biochemical diagnosis of LCHAD or TFP deficiency, to provide molecular confirmation of the diagnosis. The most common pathogenic variant in isolated LCHAD deficiency is the p.E510Q (c.1528G>C) variant, accounting for an allele frequency of 87% in LCHAD deficient patients.


Full sequencing of HADHA and HADHB genes can be ordered sequentially or simultaneously, as appropriate.

Sample Requirements

Specimen: Whole blood, cord blood

Container(s): Lavender/EDTA, Yellow/ACD A or B

Preferred Vol: 3 mL

Minimum Vol: 1 mL


Note: Heparin samples (Green tops) are unacceptable.


Specimen: Extracted DNA

Minimum: 10µg

Note: DNA concentration minimum 50 µg/mL; 260/280 ratio 1.70-2.00


Specimen: Cultured cells

Acceptable:  Fibroblasts

Container(s): T-25 flasks

Preferred Vol: 2 flasks

Processing Instructions

Reject due to: Heparin

Spin: No

Aliquot: No

Temp: Refrigerate

Storage location: Molecular Genetics box in CPA refrigerator #2


Off-site collection: Refrigerate blood samples until ready to ship.  Transport all sample types at room temperature via overnight shipping.


Specimen Type Temperature Time
Cultured cells Room temp 3 days
Whole blood, extracted DNA Room temp 3-5 days
Whole blood, extracted DNA Refrigerated 7 days
Extracted DNA Frozen ok


Note: Whole blood samples > 7days may be submitted to be assessed by our lab for acceptability for testing.


STAT Performed TAT
Contact lab Monday - Friday 2-3 weeks


Performing Laboratory

Seattle Children's Laboratory


Department:  Molecular Genetics Laboratory

Phone: 206-987-3872


Lab Client Services: 206-987-2617


Lab Genetic Counselor:

Reference Range

Interpretive report will be provided


Method: Bi-directional sequencing of all exons and exon-intron boundaries


Limitations: This test will indentify >97% of sequence variants in the coding region and splice junctions. Pathogenic variants in the promoter region, large deletions, large duplications, or rare recombinant pathogenic variants may not be detected by this method.

CPT Codes

HADHA 81406, HADHB 81479   (updated 1/27/16 by dstern)

Special Instructions

Please indicate on the requisition which gene(s) are requested and sequencing preference (simultaneous or sequential)


Links to: LCHAD E-Medicine Review Article; LCHAD OMIM Entry; Trifunctional Protein Deficiency OMIM Entry


Molecular Genetics

Clinical Utility

Long-chain-hydroxy Acyl-CoA dehydrogenase deficiency (LCHAD), and mitochondrial trifunctional protein deficiency (TFP) are disorders of long-chain fatty acid metabolism. They have overlapping clinical presentation that can include: feeding difficulties, lethargy, hypoglycemia, muscle weakness and liver dysfunction in infancy or early childhood. These symptoms are often triggered by prolonged fasting or viral infections. Muscle pain, breakdown of muscle tissue and peripheral neuropathy may occur later in childhood. These patients are at risk for complications such as life-threatening heart problems and sudden unexpected death. Carrier women pregnant with affected fetuses can develop Acute Fatty Liver of Pregnancy (AFLP).

The mitochondrial trifunctional protein consists of 3 enzymes that work together to metabolize long-chain fats. Most patients have isolated deficiency of the LCHAD enzyme caused by pathogenic variants in the HADHA gene. A small portion of patients have defects in all three enzymes, called TFP deficiency, which is due to pathogenic variants in the HADHA or HADHB gene.


Full sequencing of HADHA and HADHB genes can be ordered sequentially or simultaneously, as appropriate.