Indican interference with six commercial procedures for measuring total bilirubin.

We have studied the effect of indican on six commercial procedures for the measurement of total bilirubin in serum. Total bilirubin measured by the Bilirubin A-Gent (Abbott) 2,4-dichlorophenyl diazonium procedure increased by 50 mg/L for each 1 mmol/L of added indican. Similarly, total bilirubin measured by the Bilirubin C-System (Boehringer Mannheim) 2,5-dichlorophenyl diazonium procedure increased by 33 mg/L per mmol/L of indican. Indican also interfered with the Micro Bilirubin Reagent Set (Harleco) Malloy-Evelyn procedure, but to a much lesser extent. The Jendrassik Bilirubin Reagent System (American Monitor) and a modified Jendrassik-Grof procedure (Hoffmann-LaRoche) adapted to the Cobas Bio analyzer were unaffected by the presence of indican. The amount of interference with the 2,5-dichlorophenyl diazonium procedure increased significantly with color development time and was twice the initial amount after 30 min. Concentrations of indican as high as 0.38 mmol/L have been found in sera of patients with renal failure, which would increase total bilirubin values measured by the first two procedures above by 19 and 12 mg/L, respectively. Users of these procedures should therefore be suspicious of unexpectedly high bilirubin values obtained with sera from patients with chronic renal disease.