K Number
K040275
Manufacturer
Date Cleared
2004-02-27

(22 days)

Product Code
Regulation Number
864.5425
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

For use as a quality control plasma to monitor the precision of laboratory testing procedures for the analytes listed in this package in on the

Device Description

Lyphochek® Hemostasis Control is prepared from human plasma with added purified biochemicals and preservatives. The control is provided in lyophilized form for increased stability.

AI/ML Overview

The provided document describes the Lyphochek® Hemostasis Control, a quality control plasma. It does not describe an AI medical device or a study comparing AI performance against human performance. Therefore, I cannot provide information on acceptance criteria, sample sizes for test/training sets, expert qualifications, adjudication methods, MRMC studies, or standalone algorithm performance as these are not relevant to the given document.

The document focuses on demonstrating substantial equivalence to a predicate device (K020878) based on similarities in intended use, form, matrix, storage, and reconstituted stability claims, and verifying the stability of the new device for the specified analytes.

Here is the information that can be extracted from the provided text regarding the Lyphochek® Hemostasis Control:

1. Table of Acceptance Criteria and Reported Device Performance

The document does not explicitly state "acceptance criteria" in the traditional sense of a performance study for an AI device. Instead, it details product claims related to stability, which are effectively the performance characteristics that the device is intended to meet.

Performance CharacteristicAcceptance Criteria (Product Claim)Reported Device Performance
Reconstituted StabilityAll analytes stable for 8 hours at 2-25°C. Exception: Protein S stable for 8 hours at 2-8°C.Product claims states these conditions are met.
Shelf LifeThree years when stored at 2-8°C.Product claims states this condition is met.
Ongoing StudiesReal-time studies will be ongoing to support the shelf life of this product.Confirmed that studies are ongoing to support the shelf life.
Analytes IncludedProthrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen, Antithrombin III (AT III) Thrombin Time (TT), Factor II, V, VII, VIII, IX, X, XI, XII, Protein S (Functional) Protein C (Functional), Plasminogen, and D-dimer.The device contains all listed analytes.

2. Sample Size Used for the Test Set and Data Provenance

The document does not mention a "test set" or provide specific sample sizes for stability studies. It states that "All supporting data is retained on file at Bio-Rad Laboratories," indicating that data exists but is not elaborated upon in the summary. Data provenance (country of origin, retrospective/prospective) is not mentioned.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications

Not applicable. This device is a quality control material, not an AI diagnostic device requiring expert interpretation for ground truth establishment.

4. Adjudication Method for the Test Set

Not applicable. This device is a quality control material.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done

No. This is not an AI diagnostic device designed to be used by human readers, so an MRMC study comparing human readers with and without AI assistance is not relevant.

6. If a Standalone (i.e. algorithm only without human-in-the loop performance) Was Done

No. This is not an AI algorithm.

7. The Type of Ground Truth Used

For a quality control product, the "ground truth" would be the assayed target values of the analytes within the control material, established through precise analytical methods and often an internal reference measurement system. The document does not specify how these target values were established.

8. The Sample Size for the Training Set

Not applicable. This is not an AI algorithm requiring a training set.

9. How the Ground Truth for the Training Set Was Established

Not applicable. This is not an AI algorithm.

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Page 1 of 2

K040275

Summary of Safety and Effectiveness FEB 2 7 2004 Lyphochek® Hemostasis Control

1.0 Submitter

Bio-Rad Laboratories 9500 Jeronimo Road, Irvine, California 92618-2017 (949) 598-1200 Telephone: (949) 598-1557 Fax:

Contact Person

Maria Zeballos Requlatory Affairs Specialist (949) 598-1367 Telephone:

Date of Summary Preparation

January 30, 2004

2.0 Device Identification

Product Trade Name:Lyphochek® Hemostasis Control
Common Name:Control Plasma Normal and Abnormal
Classifications:Class II
Product Code:GGC
Regulation Number:21 CFR 864.5425

Device to Which Substantial Equivalence is Claimed 3.0

Lyphochek Hemostasis Control Bio-Rad Laboratories Irvine, California

510(k) Number: K020878

Description of Device 4.0

Lyphochek® Hemostasis Control is prepared from human plasma with added purified biochemicals and preservatives. The control is provided in lyophilized form for increased stability.

Statement of Intended Use 5.0

Lyphochek® Hemostasis Control is intended for use as a quality control plasma to monitor the precision of laboratory analytes listed in the package insert.

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Comparison of the new device with the Predicate Device 6.0

Table 1 (below) contains comparison information of similarities and differences between the new Lyphochek Hemostasis Control and the currently marketed Lyphochek Hemostasis Control ((020878) to which substantial equivalence is claimed. The new Lyphochek Hemostasis Control is a tri-level product (Levels 1, 2 and 3) and contains D-dimer. The Lyphochek Hemostasis Control is a bi-levels 1 and 2) product and does not contain D-dimer.

CharacteristicsBio-RadLyphochek® Hemostasis Control(New Device)Bio-RadLyphochek® Hemostasis Control(Predicate DeviceK020878)
Similarities
Intended UseLyphochek® Hemostasis Control is intended for use asa quality control plasma to monitor the precision oflaboratory testing procedures for analytes listed in thepackage insert.Lyphochek® Hemostasis Control is intended for use as aa quality control plasma to monitor the precision oflaboratory testing procedures for analytes listed in thepackage insert.
FormLyophilizedLyophilized
MatrixHuman plasma basedHuman plasma based
Storage (Unopened)2-8°C until expiration date2-8°C until expiration date
Reconstituted VialClaim8 hours at 2-25°C with the following exception:Protein S will be stable for 8 hours at 2- 8°C.8 hours at 2-25°C with the following exception:Protein S will be stable for 8 hours at 2- 8°C.
Differences
LevelsLevels 1, 2 and 3Levels 1 and 2Does not contain Level 3
AnalytesContains: Prothrombin Time (PT), Activated PartialThromboplastin Time (APTT), Fibrinogen, AntithrombinIII (AT III) Thrombin Time (TT), Factor II, V, VII, VIII, IX,X, XI, XII, Protein S (Functional) Protein C (Functional),Plasminogen and D-dimerContains: Prothrombin Time (PT), Activated PartialThromboplastin Time (APTT), Fibrinogen, Antithrombin III(AT III) Thrombin Time (TT), Factor II, V, VII, VIII, IX, X, XI,XII, Protein S (Functional) and Protein C (Functional),PlasminogenDoes not Contain: D-dimer

Table 1. Similarities and Differences between new and predicate device.

7.0 Summary of Performance Data

Stability studies have been performed to determine the reconstituted stability and shelf life for the Lyphochek® Hemostasis Control. Product claims are as follows:

  • Reconstituted Stability: All analytes will be stable for 8 hours at 2 -25℃ with the exception of 2.1 Protein S which will be stable for 8 hours at 2 - 8℃.
  • 2.2 Shelf Life: Three years when stored at 2 8 °C
  • 2.3 Real time studies will be ongoing to support the shelf life of this product.

All supporting data is retained on file at Bio-Rad Laboratories.

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" arranged around the perimeter. Inside the circle is an abstract symbol resembling an eagle or bird in flight, composed of three curved lines.

FEB 27 2004

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

Ms. Elizabeth Platt Regulatory Affairs/Quality Assurance Manager Bio-Rad Laboratories, QSD 9500 Jeronimo Road Irvine, California 92618-2017

K040275 Rc: Trade/Device Name: Lyphochek Hemostasis Control Regulation Number: 21 CFR § 864.5425 Regulation Name: Multipurpose System for in vitro coagulation studies Regulatory Class: II Product Code: GGN Dated: January 30, 2004 Received: February 5, 2004

Dear Ms. Platt:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Parts 801 and 809); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820). This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

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Page 2

If you desire specific information about the application of labeling requirements to your device, or questions on the promotion and advertising of your device, please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (301) 594-3084. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Joseph L. Arallett

Joseph L. Hackett, Ph.D. Acting Director Division of Immunology and Hematology Devices Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

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510 (k) Number (if known): K040275

Device Name: Lyphochek Hemostasis Control

Indications for Use:

For use as a quality control plasma to monitor the precision of laboratory testing procedures for the analytes listed in this package in on the

Analytes listed in the package insert:

  • . Antithrombin III (AT III)
  • Activated Partial Thromboplastin Time (APTT) .
  • D-dimer ◆
  • . Factor II
  • Factor V .
  • Factor VII .
  • Factor Vill .
  • Factor IX .
  • Factor XI .
  • Factor XII ◀
  • . Fibrinogen
  • . Plasminogen
  • Protein C (Functional) .
  • Protein S (Functional) .
  • Prothrombin Time (PT)
    • Thrombin Time (TT)

Division Sign-Off

Office of In Vitro Diagnostic Device Evaluation and Safety

(PLEASE DO NOT WRITE BELOW THE LINE-CONINUE ON ANOTHER PAGE IF NEEDED)
510(K)_________________________________________________________________________________________________

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription use ___ or

Over-the Counter use

§ 864.5425 Multipurpose system for in vitro coagulation studies.

(a)
Identification. A multipurpose system for in vitro coagulation studies is a device consisting of one automated or semiautomated instrument and its associated reagents and controls. The system is used to perform a series of coagulation studies and coagulation factor assays.(b)
Classification. Class II (special controls). A control intended for use with a multipurpose system for in vitro coagulation studies is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 864.9.