K Number
K142132
Device Name
POOL NORM
Date Cleared
2014-12-12

(130 days)

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

The Pool Norm is a normal human plasma pool intended for use as a normal control for the activated partial thromboplastin time (APTT) and dilute Russell's viper venom time (dRVVT) assays carried out with the following tests:

  • APTT: STA® - PTT A (REF 00595) on STA-R®, STA Compact® and STA Satellite® analyzers
  • dRVVT: STA® - Staclot® dRVV Screen (REF 00339, 00333), STA® - Staclot® dRVV Confirm (REF 00334) on STA-R® and STA Compact® analyzers.
    This reagent is to be used in clinical laboratories by certified medical laboratory personnel. For in vitro diagnostic use only. For prescription use.
Device Description

Pool Norm is a lyophilized pool of at least 20 citrated normal human plasmas, containing buffer, stabilizers and preservatives.

AI/ML Overview

The provided document describes the Pool Norm device, a normal human plasma pool intended for use as a normal control for activated partial thromboplastin time (APTT) and dilute Russell's viper venom time (dRVVT) assays. The study presented focuses on the device's precision performance.

Here's a breakdown of the requested information:

1. Table of acceptance criteria and the reported device performance

The document does not explicitly state "acceptance criteria" for the reported precision study. However, the study aims to demonstrate repeatability (within-run precision) and within-laboratory precision, which are standard measures for the performance of control materials. The reported performance is given as Standard Deviation (SD) in seconds and Coefficient of Variation (CV) in percentage for three different lots of Pool Norm on three different analyzer types.

Since explicit acceptance criteria are not provided, we will assume that the reported precision values are considered acceptable by the manufacturer for the intended use of the device. A common industry expectation for coagulation controls is a CV of less than 5% for within-laboratory precision, though this can vary. All reported CVs are well below this general benchmark.

AssayAnalyzer TypeSample Pool Norm LotPerfromance MetricReported Performance (SD (sec) / CV (%))(Assumed) Acceptance Criteria (Example)
STA® - PTT ASTA-R®110150Repeatability0.3 sec / 1.0 %CV < 2% (Typical for APTT repeatability)
Within-Lab Precision0.6 sec / 1.7 %CV < 5% (Typical for APTT W-L precision)
STA® - Staclot® dRVV ScreenSTA-R®110150Repeatability0.3 sec / 0.8 %CV < 2% (Typical for dRVVT repeatability)
Within-Lab Precision0.6 sec / 1.4 %CV < 5% (Typical for dRVVT W-L precision)
STA® - Staclot® dRVV ConfirmSTA-R®110150Repeatability0.3 sec / 0.8 %CV < 2% (Typical for dRVVT repeatability)
Within-Lab Precision0.5 sec / 1.3 %CV < 5% (Typical for dRVVT W-L precision)
STA® - PTT ASTA Compact®110150Repeatability0.5 sec / 1.6 %CV < 2%
Within-Lab Precision0.7 sec / 2.1 %CV < 5%
STA® - Staclot® dRVV ScreenSTA Compact®110150Repeatability0.3 sec / 0.7 %CV < 2%
Within-Lab Precision0.6 sec / 1.6 %CV < 5%
STA® - Staclot® dRVV ConfirmSTA Compact®110150Repeatability0.3 sec / 0.9 %CV < 2%
Within-Lab Precision0.5 sec / 1.4 %CV < 5%
STA® - PTT ASTA Satellite®110150Repeatability0.1 sec / 0.4 %CV < 2%
Within-Lab Precision0.3 sec / 0.9 %CV < 5%
Note: The "Assumed Acceptance Criteria" are typical industry benchmarks for precision of coagulation controls and are not explicitly stated in the document as acceptance criteria.

2. Sample size used for the test set and the data provenance

  • Sample Size for Test Set: For each lot of Pool Norm tested on each analyzer, "N" is reported as 80. The study was performed for 20 days, with 2 runs per day. This means 40 measurements per lot for repeatability (2 runs x 20 days) and 40 measurements per lot over 20 days for within-laboratory precision. The "N=80" stated in the tables likely refers to the total number of data points collected for the precision calculation (e.g., 2 runs/day * 20 days * 2 replicates per run or similar, though the details of the "N=80" are not fully elaborated beyond the 20 days, 2 runs per day). Given the context of a precision study, N=80 refers to the total number of individual measurements used for calculation within each lot and assay combination.
  • Data Provenance: The study was "performed in-house". The company, Diagnostica Stago, is based in Gennevilliers, France. Therefore, the data provenance is likely retrospective (as it's a pre-submission study report) and from France (where the company is located).

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

This information is not applicable to this study. The "Pool Norm" device is a control material, not a diagnostic device that interprets patient data. The study is evaluating the precision (reproducibility) of the control material itself when used in coagulation assays. Ground truth in the sense of a clinical diagnosis or interpretation derived from expert review is not relevant here. The "ground truth", if one were to stretch the definition, would be the true, intrinsic coagulation activity of the plasma pool, which is measured by the assays.

4. Adjudication method for the test set

This information is not applicable. Since there is no "ground truth" based on expert interpretation, there is no need for an adjudication method. The study is a quantitative measurement of inherent device variability.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

This information is not applicable. The device is a laboratory reagent (a normal human plasma pool for use as a control), not an AI-powered diagnostic imaging system or similar device that would involve human "readers" or AI assistance.

6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done

This information is not applicable. The device is a diagnostic reagent, and the study evaluates its precision, not an algorithm's performance.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

As mentioned in point 3, the concept of "ground truth" in the typical diagnostic sense is not applicable. The study assesses the inherent precision of the control material (Pool Norm) through repeated quantitative measurements in standard laboratory assays (APTT, dRVVT). The "true" value of the control's coagulation time is inherent to the material and is estimated by the mean (X) of the repeated measurements.

8. The sample size for the training set

This information is not applicable as there is no "training set" for this type of device. The study is a performance validation of a reagent, not a machine learning model.

9. How the ground truth for the training set was established

This information is not applicable as there is no training set or clinical "ground truth" in this context.

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle or bird symbol to the right of the text. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement around the left side of the logo. The bird symbol is composed of three overlapping profiles facing to the right.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

December 12, 2014

Diagnostica Stago Ms. Marie Compagnon-Riobe Registration & Reagent Documentation Manager 125 Avenue Louis Roche 92230 Gennevilliers, France

Re: K142132

Trade/Device Name: Pool Norm Plasma Regulation Number: 21 CFR 864.5425 Regulation Name: Multipurpose system for in vitro coagulation studies Regulatory Class: II Product Code: GGN Dated: November 4, 2014 Received: November 6, 2014

Dear Ms. Compagnon-Riobe:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. 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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the

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electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulations (21 CFR Parts 801 and 809), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638 2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm. 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 Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely vours.

Maria M. Chan -S

Maria M. Chan, Ph.D. Director Division of Immunology and Hematology Devices Office of In Vitro Diagnostics and Radiological Health Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K142132

Device Name POOL NORM

Indications for Use (Describe)

The Pool Norm is a normal human plasma pool intended for use as a normal control for the activated partial thromboplastin time (APTT) and dilute Russell's viper venom time (dRVVT) assays carried out with the following tests:

  • APTT: STA® - PTT A (REF 00595) on STA-R®, STA Compact® and STA Satellite® analyzers - dRVVT: STA® - Staclot® dRVV Screen (REF 00339, 00333), STA® - Staclot® dRVV Confirm (REF 00334) on STA-R® and STA Compact® analyzers.

This reagent is to be used in clinical laboratories by certified medical laboratory personnel. For in vitro diagnostic use only. For prescription use.

Type of Use (Select one or both, as applicable)

2 Prescription Use (Part 21 CFR 801 Subpart D)

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

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY
Submitter's Information:Diagnostica Stago S.A.S.
125 avenue Louis Roche
92230 Gennevilliers
France
Contact Person:Marie Compagnon-Riobé
Registration Manager and Regulatory Affairs Coordinator
Phone: 011-33- 1 41 47 16 11
Fax: 011-33- 1 41 47 57 50
Date Prepared:December 12th, 2014
Device Name:Pool Norm
Device Classification:Class IIRegulation Number: 21 CFR 864.5425Panel: Hematology (81)Product Code: GGN
Predicate Devices:- Pooled Normal Plasma - Pre-amendment deviceGeorge King Bio-Medical, INC- STA® - Control LA 1 - K061803Diagnostica Stago
Device Intended Use:The Pool Norm is a normal human plasma pool intended foruse as a normal control for the activated partialthromboplastin time (APTT) and dilute Russell's viper venomtime (dRVVT) assays carried out with the following tests:
- APTT: STA® - PTT A (REF 00595) on STA-R®, STACompact® and STA Satellite® analyzers
- dRVVT: STA® - Staclot® dRVV Screen (REF 00339,00333), STA® - Staclot® dRVV Confirm (REF 00334) onSTA-R® and STA Compact® analyzers.
This reagent is to be used in clinical laboratories by certifiedmedical laboratory personnel. For in vitro diagnostic useonly. For prescription use.
Device Description:Pool Norm is a lyophilized pool of at least 20 citrated normalhuman plasmas, containing buffer, stabilizers andpreservatives.

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

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Image /page/3/Picture/0 description: The image shows the logo for Stago. The logo consists of the word "Stago" in a serif font, with the first letter capitalized and the rest in lowercase. Above the word "Stago" is an abstract graphic element. The graphic element appears to be composed of two shapes, one in a reddish-brown color and the other in a grayish-brown color, arranged in a way that suggests a stylized, incomplete circle or a stylized eye.

510(k) Summary

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Image /page/4/Picture/0 description: The image shows the logo for Stago. The logo consists of the word "Stago" in a serif font, with the letters in a reddish-brown color. Above the word is an abstract graphic element, also in reddish-brown and gray. The graphic element appears to be two curved shapes, one red and one gray, that are positioned to suggest movement or flow.

Summary of precision performance data

Repeatability/Within- Laboratory Precision Study was performed in-house according to the CLSI guideline document EP05-A2 (3). Pool Norm was tested for 20 days, 2 runs per day. Test data are presented below:

  • on STA-R®
AssaySamplePool NormLotNX(sec)RepeatabilityWithin-LaboratoryPrecision
SD(sec)CV(%)SD(sec)CV(%)
STA® - PTT A1101501107951112898033.132.632.50.30.30.31.01.00.90.60.50.51.71.61.5
STA® - Staclot®dRVV Screen1101501107951112898042.441.641.20.30.20.20.80.60.40.60.50.51.41.31.1
STA® - Staclot®dRVV confirm1101501107951112898038.237.937.70.30.30.30.80.80.70.50.50.41.31.31.1
  • on STA Compact®
AssaySamplePool NormLotNX(sec)RepeatabilityWithin-LaboratoryPrecision
SD(sec)CV(%)SD(sec)CV(%)
STA® - PTT A1101508033.00.51.60.72.1
11079532.70.41.20.61.7
11128932.50.51.50.72.1
STA® - Staclot®dRVV Screen1101508040.50.30.70.61.6
11079540.00.30.70.61.4
11128939.40.40.90.71.8
STA® - Staclot®dRVV confirm1101508037.00.30.90.51.4
11079536.50.51.40.71.9
11128936.40.41.00.51.4
  • on STA Satellite®
AssaySamplePool NormLotNX(sec)RepeatabilityWithin-LaboratoryPrecision
SD(sec)CV(%)SD(sec)CV(%)
11015033.50.10.40.30.9
STA® - PTT A1107958033.10.10.20.30.9
11128933.10.10.30.30.9

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Image /page/5/Picture/0 description: The image shows the logo for Stago. The logo consists of the word "Stago" in a serif font, with the letters in a reddish-brown color. Above the word "Stago" is an abstract symbol that appears to be composed of two curved shapes, one in a reddish-brown color and the other in a grayish-brown color. The symbol is positioned to suggest movement or flow.

Substantial Equivalence Comparison Table:

Attributes orCharacteristicsPool Norm(Diagnostica Stago)Subject devicePooled Normal Plasma(George King Bio-Medical)Predicate deviceSTA® - Control LA 1(Diagnostica Stago)Predicate device
Intended UseNormal control for theactivated partialthromboplastin time(APTT) and diluteRussell's viper venomtime (dRVVT) assayscarried out with thefollowing tests:- APTT: STA® - PTT A(REF 00595) on STA-R®, STA Compact® andSTA Satellite® analyzers- dRVVT: STA® -Staclot® dRVV Screen(REF 00339, 00333),STA® - Staclot® dRVVConfirm (REF 00334) onSTA-R® and STACompact® analyzers.This reagent is to be usedin clinical laboratories bycertified medicallaboratory personnel. Forin vitro diagnostic useonly. For prescriptionuse.Control plasma intendedto be used to monitorcoagulation tests.For in vitro diagnosticuse only.Lupus anticoagulant(LA) negative plasmaintended for the qualitycontrol of the tests forLA detection carried outwith the followingtests:- STA® - Staclot® dRVVScreen (REF 00339,00333)- STA® - Staclot® dRVVConfirm (REF 00334)Staclot® LA (REF00600, 00594).For in vitro diagnosticuse only.
Assay valuesreportingLot-specific Certificateof analysis:- reporting assay valuesfor Activated PartialThromboplastin Time(APTT),- certifying negativetesting for lupusanticoagulant.Lot-specific Certificateof analysis:- reporting assay valuesfor Prothrombin Time(PT), Activated PartialThromboplastin Time(APTT), Fibrinogen,Factors V, VII, VIII, IX,X, XI and XIILot-specific Certificateof analysis:- reporting controlvalues forSTA® - Staclot® dRVVScreen, STA® - Staclot®dRVV Confirm andStaclot® LA
Test procedureSame manner as patients'samplesSameAutomatically used bythe instruments
MatrixPooled citrated humanplasma from normaldonorsSameLA negative citratedhuman plasma
FormLyophilizedFrozenLyophilized
Attributes orCharacteristicsPool Norm(Diagnostica Stago)Subject devicePooled Normal Plasma(George King Bio-Medical)Predicate deviceSTA® - Control LA 1(Diagnostica Stago)Predicate device
In-use stability8 hours at 20 ± 5 °C2 hours after beingthawed at 37 °C*8 hours at 20 ± 5 °C*8 hours on the STACompact® and STA-R®
AnatomicalSitesNot applicable. No directpatient contactSameSame
Storage2-8 °C≤ - 70 °C2-8 °C
SterilityNo sterility requirements.No direct patient contactSameSame
BiocompatibilityNo biocompatibilityrequirements. No directpatient contactSameSame
Chemical SafetyNo issues regardingchemical safety due to nodirect patient contactSameSame

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Image /page/6/Picture/0 description: The image shows the logo for Stago. The logo features the word "Stago" in a red, serif font. Above the word is an abstract graphic consisting of two curved shapes, one red and one gray, arranged in a circular fashion. The red shape is larger and positioned above the gray shape.

§ 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.