EXPRESS: A survey of the reactivity of in-vitro diagnostic bilirubin reagents developed in Japan using artificially prepared bilirubin materials: A comparison of synthetic delta, unconjugated, and taurine-conjugated bilirubin

Background: In-vitro diagnostic (IVD) bilirubin reagents based on oxidation with bilirubin oxidase (BOX) or vanadic acid (VA) for total and direct-reacting bilirubin (TB and DB) are widely used in Japan; however, their reactivity to unconjugated and conjugated bilirubin (UCB and CB) and delta bilirubin (DLB) has not been completely disclosed by manufacturers. We used artificially prepared bilirubin materials to investigate the reactivity with four IVD bilirubin reagents. Methods: Porcine UCB solution, chemically synthesized ditaurobilirubin (DTB) solution, and chemically synthesized DLB solution were used as surrogates of naturally occurring UCB, CB, and DLB, respectively. The TB and DB concentrations were measured by three BOX methods and one VA method, and the observed concentrations were compared with those obtained by the diazo-based reference measurement procedure (RMP). Results: The UCB and DLB concentrations were similar when any of the four IVD bilirubin reagents were used during TB measurement. This was consistent with RMP and exhibited a converged inter-method variation. Compared with RMP, significantly low DTB concentrations were observed by the IVD bilirubin reagents despite the converged inter-method variation. In DB measurement, some reagents reacted doubtfully with UCB, while showed lower DTB concentrations than its corresponding TB concentration. Reactivity with DLB was different for each method including RMP. Some reagents were developed to react less with DLB and others to strongly react with DLB. Conclusions: We revealed the reactivity of IVD-TB and IVD-DB reagents to artificially prepared bilirubin materials, and their consistency with RMP. The DB data results vary depending on the reagents used.