K Number
K103716
Device Name
ROCHE ELECSYS FOLATE RBC; ROCHE ELECSYS FOLATE RBC CALSET
Manufacturer
Date Cleared
2011-05-12

(142 days)

Product Code
Regulation Number
862.1295
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
(1) Elecsys Folate RBC Assay: Binding assay for the in vitro quantitative determination of folate erythrocytes (red blood cells, RBCs). The binding assay is intended for use on Elecsys and cobas e immunoassay analyzers. Measurements obtained by this assay are used in the diagnosis and treatment of anemias. (2) Elecsys Folate RBC CalSet: The Elecsys Folate RBC CalSet is used for calibrating the quantitative Elecsys Folate RBC assay on the Elecsys and cobas e immunoassay analyzers. (3) Elecsys Folate RBC CalCheck: Elecsys Folate RBC CalCheck is used for the verification of the calibration established by the Elecsys Folate RBC reagent on the indicated Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.
Device Description
(1) The Elecsys Folate RBC assay employs a competitive test principle using natural folate binding protein specific for folate. Manually prepared hemolysate samples are used with this assay. Folate in the sample competes with the added folate (labeled with biotin) for the binding sites on folate binding protein (labeled with ruthenium complex). Results are determined via a calibration curve which is instrument-specifically generated by 2-point calibration and a master curve provided via the reagent barcode encoded on the reagent packaging. (2) The Elecsys Folate RBC CalSet is a lyophilized product consisting of human serum with folate in two concentration ranges. During manufacture, the analyte is spiked into the matrix. This calibrator is used to calibrate the Elecsys Folate RBC assay. (3) The Elecsys Folate RBC CalCheck is a lyophilized product consisting of a hemolysate with folic acid. During manufacture, the analyte is spiked into the matrix. This solution is used to verify the calibration established with the Elecsys Folate RBC CalSet.
More Information

Not Found

No
The description details a standard immunoassay using competitive binding and a calibration curve. There is no mention of AI/ML algorithms for data analysis, interpretation, or decision-making.

No

This device is an in vitro diagnostic (IVD) assay used to measure folate levels in red blood cells, which aids in the diagnosis and treatment of anemias. It does not directly treat or cure medical conditions.

Yes

The "Intended Use / Indications for Use" section explicitly states that "Measurements obtained by this assay are used in the diagnosis and treatment of anemias."

No

The device description clearly outlines physical components (reagents, calibrators, controls) and their use with immunoassay analyzers, indicating it is not solely software.

Yes, this device is an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use/Indications for Use: The description explicitly states "in vitro quantitative determination of folate erythrocytes (red blood cells, RBCs)" and "Measurements obtained by this assay are used in the diagnosis and treatment of anemias." This clearly indicates the device is intended for use outside of the body to analyze a biological sample (blood) for diagnostic purposes.
  • Device Description: The description details a "binding assay" using "manually prepared hemolysate samples," which are biological samples. The process involves chemical reactions and measurement of analytes within these samples.
  • Calibrators and Controls: The inclusion of "Elecsys Folate RBC CalSet" and "Elecsys Folate RBC CalCheck" further confirms its IVD nature. These are standard components of IVD assays used for calibration and quality control.
  • Explicit Statement: The description for the Elecsys Folate RBC CalCheck explicitly states "For in vitro diagnostic use."

All of these points align with the definition of an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

Folate RBC Assay: Binding assay for the in vitro quantitative determination of folate erythrocytes (red blood cells, RBCs). The binding assay is intended for use on Elecsys and cobas e immunoassay analyzers. Measurements obtained by this assay are used in the diagnosis and treatment of anemias.
Folate RBC CalSet: The Elecsys Folate RBC CalSet is used for calibrating the quantitative Elecsys Folate RBC assay on the Elecsys and cobas e immunoassay analyzers.
Folate RBC CalCheck: Elecsys Folate RBC CalCheck is used for the verification of the calibration established by the Elecsys Folate RBC reagent on the indicated Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.

(1) Elecsys Folate RBC Assay: Measurements obtained by this device are used in the diagnosis and treatment of anemias on the Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.

(2) Elecsys Folate RBC CalSet: Elecsys Folate RBC CalSet is used for calibrating the Elecsys Folate RBC assay on the Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.

(3) Elecsys Folate RBC CalCheck: Elecsys Folate RBC CalCheck is used for the verification of the calibration established by the Elecsys Folate RBC reagent on the indicated Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.

Product codes (comma separated list FDA assigned to the subject device)

CGN, JIT, JJX

Device Description

(1) The Elecsys Folate RBC assay employs a competitive test principle using natural folate binding protein specific for folate. Manually prepared hemolysate samples are used with this assay. Folate in the sample competes with the added folate (labeled with biotin) for the binding sites on folate binding protein (labeled with ruthenium complex). Results are determined via a calibration curve which is instrument-specifically generated by 2-point calibration and a master curve provided via the reagent barcode encoded on the reagent packaging.

(2) The Elecsys Folate RBC CalSet is a lyophilized product consisting of human serum with folate in two concentration ranges. During manufacture, the analyte is spiked into the matrix. This calibrator is used to calibrate the Elecsys Folate RBC assay.

(3) The Elecsys Folate RBC CalCheck is a lyophilized product consisting of a hemolysate with folic acid. During manufacture, the analyte is spiked into the matrix. This solution is used to verify the calibration established with the Elecsys Folate RBC CalSet.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K082340

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 862.1295 Folic acid test system.

(a)
Identification. A folic acid test system is a device intended to measure the vitamin folic acid in plasma and serum. Folic acid measurements are used in the diagnosis and treatment of megaloblastic anemia, which is characterized by the presence of megaloblasts (an abnormal red blood cell series) in the bone marrow.(b)
Classification. Class II.

0

K103716

Elecsys Folate RBC Test System (including Folate RBC Assay (Rack Pack), the Folate MAY 1 2 2011 RBC CalSet and the Folate RBC CalCheck)

510(k) Summary

Introduction According to the requirements of 21 CFR 807.92, the following information provides sufficient detail to understand the basis for a determination of substantial equivalence.

Submitter Roche Diagnostics name, address, 9115 Hague Road contact Indianapolis, IN 46250 (317) 521 - 3723 Contact Person: Kathie J. Goodwin

Date Prepared: December 20, 2010

1

Elecsys Folate RBC Test System (including Folate RBC Assay (Rack Pack), the Folate RBC CalSet and the Folate RBC CalCheck) Device Name Proprietary names: (1) Elecsys Folate RBC Assay (2) Elecsys Folate RBC CalSet and (3) Elecsys Folate RBC CalCheck

Device Descriptions (1) Folate RBC Assay (2) Folate RBC CalSet (3) Folate RBC CalCheck

Classification names: (1) Folic Acid Test System (2) Calibrator, Secondary

(3) Quality Control Material (Assayed and Unassayed)

Product codes: (1) CGN (2) JIT (3) JJX

Common names:

(1) The Elecsys Folate RBC assay employs a competitive test principle using natural folate binding protein specific for folate. Manually prepared hemolysate samples are used with this assay. Folate in the sample competes with the added folate (labeled with biotin) for the binding sites on folate binding protein (labeled with ruthenium complex). Results are determined via a calibration curve which is instrument-specifically generated by 2-point calibration and a master curve provided via the reagent barcode encoded on the reagent packaging.

(2) The Elecsys Folate RBC CalSet is a lyophilized product consisting of human serum with folate in two concentration ranges. During manufacture, the analyte is spiked into the matrix. This calibrator is used to calibrate the Elecsys Folate RBC assay.

(3) The Elecsys Folate RBC CalCheck is a lyophilized product consisting of a hemolysate with folic acid. During manufacture, the analyte is spiked into the matrix. This solution is used to verify the calibration established with the Elecsys Folate RBC CalSet.

2

Intended use Folate RBC Assay:

Binding assay for the in vitro quantitative determination of folate erythrocytes (red blood cells, RBCs). The binding assay is intended for use on Elecsys and cobas e immunoassay analyzers.

Folate RBC CalSet:

The Elecsys Folate RBC CalSet is used for calibrating the quantitative Elecsys Folate RBC assay on the Elecsys and cobas e immunoassay analyzers.

Folate RBC CalCheck:

Elecsys Folate RBC CalCheck is used for the verification of the calibration established by the Elecsys Folate RBC reagent on the indicated Elecsys and cobas e immunoassay analyzers.

Indications for Folate RBC Assay:

Use

Measurements obtained by this assay are used in the diagnosis and treatment of anemias.

Folate RBC CalSet:

Elecsys Folate RBC CalSet is used for calibrating the quantitative Elecsys Folate RBC assay on the Elecsys and cobas e immunoassay analyzers.

Folate RBC CalCheck:

Elecsys Folate RBC CalCheck is used for the verification of the calibration established by the Elecsys Folate RBC reagent on the indicated Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.

Substantial The Elecsys Folate RBC Test System is substantially equivalent to the equivalence Elecsys RBC Folate III Test System. This test system was previously cleared in K082340.

Continued on next page ... ...

3

Elecsys Folate RBC Test System (including Folate RBC Assay (Rack Pack), the Folate RBC CalSet and the Folate RBC CalCheck)

510(k) Summary, Continued

Substantial equivalence -comparison

(1) Elecsys Folate RBC Assay
FeatureElecsys Folate RBC AssayPredicate Device: Elecsys RBC Folate III Assay (K082340)
Intended UseElecsys Folate RBC binding assay is used for the in vitro quantitative determination of folate in erythrocytes (red blood cells, RBC). The assay is intended for use on Elecsys and cobas e immunoassay analyzers.Elecsys RBC Folate Hemolyzing Reagent is used together with the Elecsys Folate III assay for the quantitative determination of folate in erythrocytes (Red blood cell folate; RBC folate) on the Elecsys 2010 and cobas e 411 immunoassay analyzers.
Indication for UseSameThis assay may be used as an aid in the diagnosis and treatment of anemias.
Assay ProtocolSameElectrochemiluminescent Immunoassay
Sample TypeSameNa-Heparin and K3-EDTA
Labeled Instrument PlatformRoche Elecsys 2010/ cobas e 411 and Modular E170/cobas e 601/602 analyzersRoche Elecsys 2010/ cobas e 411 analyzers
CalibratorElecsys Folate RBC CalSetElecsys Folate III CalSet
Calibration frequencySameOnce per reagent lot and
• After 1 month when using same reagent lot
• After 7 days when using same reagent kit on the analyzer
• As required per QC findings or pertinent regulations
ControlsCommercially available whole blood controlElecsys PreciControl Anemia
TraceabilityReference method is Folate III (Application on the E2010)Reference method is the Elecsys Folate II assay
Reagent StabilityUnopened - Same
Opened - Same
On analyzers - 2 weeksUnopened 2-8℃ - up to expiration
Opened 2-8℃ - 8 weeks
On Elecsys 2010 and cobas e411- 2 weeks
Measuring Range120 ng/mL - 620 ng/mL46.5 - 620 ng/mL
Analytical Sensitivity at Lower LimitsLoB ≤ 20 ng/mL
LoD ≤ 46.5 ng/mL
LoQ ≤ 120.0 ng/mLLoB ≤ 19.84 ng/mL
LoD ≤ 46.5 ng/mL
LoQ ≤ 62.0 ng/mL
RBC CalSet and the Folate RBC CalCheck)
DilutionSamples with folate concentrations above
the measuring range can be diluted
manually with Folate RBC Hemolyzing
Reagent (ascorbic acid solution, 0.2%).
The recommended dilution is 1:2. The
concentration of the diluted sample must
be >265 ng/mL. After manual dilution,
multiply the results by the dilution factor
  1.                                                                                                                                                                                | Samples with folate concentrations
    

above the measuring range can be
manually diluted with 0.2% ascorbic
acid solution. The recommended
dilution is 1:2. The concentration of the
diluted sample must be > 310 ng/mL.
Multiply the result by the dilution factor. |
| Precision | Elecsys 2010/cobas e411 Repeatability Hemolysate 2, mean 155 ng/mL:
SD 7.73 ng/mL; CV 5.0% Hemolysate 3, mean 272 ng/mL:
SD 11.2 ng/mL; CV 4.1% Hemolysate 4, mean 527 ng/mL:
SD 17.1 ng/mL; CV 3.3% | Elecsys 2010/cobas e411 Repeatability Sample 1, mean 229 ng/mL: SD 12.2
ng/mL; CV 5.3% Sample 2, mean 350 ng/mL: SD 17.0
ng/mL; CV 4.9% Sample 3, mean 481 ng/mL: SD 25.7
ng/mL; CV 5.3% |
| | Elecsys Modular E170/cobas e 601/602
Repeatability Hemolysate 2, mean 191 ng/mL:
SD 11.5 ng/mL; CV 6.0% Hemolysate 3, mean 258 ng/mL:
SD 14.1 ng/mL; CV 5.5% Hemolysate 4, mean 580 ng/mL:
SD 12.8 ng/mL; CV 2.2% | |
| | Elecsys 2010/cobas e411 Intermediate
Precision Hemolysate 2, mean 155 ng/mL:
SD 12.2 ng/mL; CV 7.9% Hemolysate 3, mean 272 ng/mL:
SD 16.9 ng/mL; CV 6.2% Hemolysate 4, mean 527 ng/mL:
SD 24.8 ng/mL; CV 4.7% | Elecsys 2010/cobas e411 Intermediate
Precision Sample 1, mean 229 ng/mL: SD 16.1
ng/mL; CV 7.0% Sample 2, mean 350 ng/mL: SD 25.2
ng/mL; CV 7.2% Sample 3, mean 481 ng/mL: SD 34.6
ng/mL; CV 7.2% |
| | Elecsys Modular E170/cobas e 601/602
Intermediate Precision Hemolysate 2, mean 191 ng/mL:
SD 12.5 ng/mL; CV 6.5% Hemolysate 3, mean 258 ng/mL:
SD 15.1 ng/mL; CV 5.9% Hemolysate 4, mean 580 ng/mL:
SD 19.7 ng/mL; CV 3.4% | |
| Analytical
Specificity | Same | The following cross-reactivities were
found:
Aminopterin 2.7%
Folinic acid 2.3%
Amethopterin 2.3% |
| | RBC CalSet and the Folate RBC CalCheck) | |
| Interferences | Same
Also includes the following
precautionary statement for high
protein samples:
Samples with extremely high
total protein concentrations (e.g.
patients suffering from
Waldenstrom's
macroglobulinemia) are not
suitable for use in this assay,
since they may lead to the
formation of protein gel in the
assay cup. Processing protein gel
may cause a run abort. The
critical protein concentration is
dependent upon the individual
sample composition and the
sample type. | The assay is unaffected by icterus
(bilirubin Criterion: Recovery within ± 10% of initial value
with samples >5 ng/mL and < +/- 0.5 ng/mL
with samples ≤ 5 ng/mL. In patients receiving therapy with high
biotin doses (i.e. >5 mg/day), no sample
should be taken until at least 8 hours
after the last biotin administration. No interference was observed from
rheumatoid factors up to a concentration
of 1000 IU/mL. In vitro tests were performed on 18
commonly used pharmaceuticals and in
addition on human erythropoietin. No
interference with the assay was found. It is contraindicated to measure samples
of patients receiving therapy with certain
pharmaceuticals, e.g. methotrexate or
leucovorin, because of the cross-
reactivity of folate binding protein with
these compounds. In rare cases, interference due to
extremely high titers of antibodies to
streptavidin and ruthenium can occur. |
| Expected Values | Whole Blood Folate (from
hemolysate sample)
Expected = 209-640 (2.5th - 97.5th
percentile)

RBC Folate (folate in
erythrocyte fraction)
Expected = 499-1504 ng/mL (2.5th - 97.5th percentile) | American Journal of Clinical Nutrition
Expected = 4.6 - 34.8 ng/mL
(all ages & male/female) |

4

Elecsys Folate RBC Test System (including Folate RBC Assay (Rack Pack), the Folate
RBC CalSet and the Folate RBC CalCheck)

5

.

'

Elecsys Folate RBC Test System (including Folate RBC Assay (Rack Pack), the Folate
RBC CalSet and the Folate RBC CalCheck)

6

Elecsys Folate RBC Test System (including Folate RBC Assay (Rack Pack), the Folate RBC CalSet and the Folate RBC CalCheck)

(2) Elecsys Folate RBC CalSet
FeatureElecsys Folate RBC CalSetPredicate
Elecsys Folate III CalSet
(K082340)
Intended UseElecsys Folate RBC CalSet is
used for calibrating the
quantitative Elecsys Folate
RBC assay on the Elecsys and
cobas e immunoassay analyzers.Elecsys Folate III CalSet is used
for calibrating the quantitative
Elecsys Folate III assay on the
Elecsys and cobas e immunoassay
analyzers.
LevelsSameTwo
MatrixHemolysate based master
calibrators and human serum
product calibratorsHuman serum
FormatSameLyophilized
StabilitySameUnopened: up to the stated
expiration date
After reconstituting:
At 2-8C - 3 days
At -20C - 3 months (freeze only
once)
Onboard: use only once
CompositionSameBuffer: HEPES 50mM
Preservative: Bronidox L 0.5%

:

Continued on next page ... ... ....

:

7

Elecsys Folate RBC Test System (including Folate RBC Assay (Rack Pack), the Folate RBC CalSet and the Folate RBC CalCheck)

(3) Elecsys Folate RBC CalCheck
FeatureElecsys Folate RBC CalCheckPredicate
Elecsys Folate III CalCheck
(K082340)
Intended UseElecsys Folate RBC CalCheck
is used in the verification of the
calibration established by the
Elecsys Folate RBC assay on
the Elecsys and cobas e
immunoassay analyzers.Elecsys Folate III CalCheck is
used for verification of the
calibration established by the
Elecsys Folate III reagent on the
Elecsys and cobas e immunoassay
analyzers.
LevelsSameThree
MatrixHemolysateHuman serum
FormatSameLyophilized
StabilitySameUnopened and stored at 2 - 8 C:
up to the stated expiration date
After reconstituting: 4 hours at
20-25C
CompositionSameBuffer: HEPES 50mM

Preservative: Bronidox L 0.5% |

End of Document

.

8

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/8/Picture/1 description: The image is a circular seal for the Department of Health & Human Services - USA. The seal features the department's name in a circular arrangement around the perimeter. In the center of the seal is a stylized image of a bird-like figure, possibly representing an eagle or other national bird. The bird is depicted with flowing lines, giving it a sense of movement and freedom.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993

HAY 1 2 2011

Roche Diagnostics C/O Ms. Kathie Goodwin 9115 Hague Rd. PO Box 50416 Indianapolis, IN 46250

Re: K103716

Trade/Device Name: Roche Elecsys Folate RBC, Folate RBC CalCheck, Folate RBC CalSet Regulation Number: 21 CFR 862.1295 Regulation Name: Folic acid test system Regulatory Class: Class II Product Code: CGN, JJX, JIT Dated: April 8, 2011 Received: April 12, 2011

Dear Ms. Goodwin:

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 class II (Special Controls), 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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

9

Page 2 -

If you desire specific advice for your device on our labeling regulation (21 CFR Parts 801 and 809), please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (301) 796-5450. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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 from mober (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

C.C.

Courthey Harper, Ph.D. Director Division of Chemistry and Toxicology Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

:

Enclosure

10

Indications for Use Form

510(k) Number (if known):

Device Name:

(1) Elecsys Folate RBC Assay (2) Elecsys Folate RBC CalSet (3) Elecsys Folate RBC CalCheck

Indications for Use:

(1) Elecsys Folate RBC Assay: Measurements obtained by this device are used in the diagnosis and treatment of anemias on the Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.

(2) Elecsys Folate RBC CalSet: Elecsys Folate RBC CalSet is used for calibrating the Elecsys Folate RBC assay on the Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.

(3) Elecsys Folate RBC CalCheck: Elecsys Folate RBC CalCheck is used for the verification of the calibration established by the Elecsys Folate RBC reagent on the indicated Elecsys and cobas e immunoassay analyzers. For in vitro diagnostic use.

Prescription Use × (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF NEEDED)

Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD)

Carol C. Benson

Division Sign-Off Office of In Vitro Diagnostic Device Evaluation and Safety

510(k) K103716

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