K Number
K160445
Device Name
HemosIL Silica Clotting Time
Date Cleared
2016-03-16

(28 days)

Product Code
Regulation Number
864.7925
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
HemosIL Silica Clotting Time is intended for the detection of Lupus Anticoagulants in human citrated plasma on the IL Coagulation Systems by the use of screening (SCT Screen) and confirmatory (SCT Confirm) reagents sensitized to phospholipid dependent antibodies. For in vitro diagnostic use.
Device Description
The HemoIL SCT assay, consisting of SCT Screen and SCT Confirm, is intended to simplify and standardize the detection of Lupus Anticoagulants (LA) in clinical evaluations. SCT Screen is poor in phospholipid making it sensitive to LA. The additional amount of phospholipid in SCT Confirm neutralizes LA to give shorter clotting times. Silica Clotting Time in the presence of calcium, directly activates the intrinsic pathway of coagulation. SCT Screen and SCT Confirm are therefore unaffected by factor VII deficiencies or inhibitors.
More Information

No
The summary describes a standard in vitro diagnostic assay based on chemical reactions and clotting time measurements, with no mention of AI or ML.

No
This device is for in vitro diagnostic use, specifically for detecting Lupus Anticoagulants, and is not directly used for treating a disease or condition.

Yes
The "Intended Use / Indications for Use" section explicitly states, "For in vitro diagnostic use." The device also detects Lupus Anticoagulants in human citrated plasma, which is a diagnostic purpose.

No

The device description clearly states it consists of "reagents" (SCT Screen and SCT Confirm), which are physical substances used in a laboratory setting for in vitro diagnostic testing. This indicates the device is not solely software.

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

The document explicitly states:

  • "For in vitro diagnostic use." in the Intended Use / Indications for Use section.
  • The device is intended for the detection of Lupus Anticoagulants in human citrated plasma, which is a biological sample tested in vitro.
  • The device is used on IL Coagulation Systems, which are laboratory instruments.

These points clearly indicate that the device is intended for testing biological samples outside of the body to provide diagnostic information.

N/A

Intended Use / Indications for Use

HemosiL Silica Clotting Time is intended for the detection of Lupus Anticoagulants in human citrated plasma on the IL Coagulation Systems by the use of screen) and confirmatory (SCT Confirm) reagents sensitized to phospholipid dependent antibodies.

Product codes

GFO

Device Description

The HemoIL SCT assay, consisting of SCT Screen and SCT Confirm, is intended to simplify and standardize the detection of Lupus Anticoagulants (LA) in clinical evaluations. SCT Screen is poor in phospholipid making it sensitive to LA. The additional amount of phospholipid in SCT Confirm neutralizes LA to give shorter clotting times. Silica Clotting Time in the presence of calcium, directly activates the intrinsic pathway of coagulation. SCT Screen and SCT Confirm are therefore unaffected by factor VII deficiencies or inhibitors.

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

K050221

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 864.7925 Partial thromboplastin time tests.

(a)
Identification. A partial thromboplastin time test is a device used for primary screening for coagulation abnormalities, for evaluation of the effect of therapy on procoagulant disorders, and as an assay for coagulation factor deficiencies of the intrinsic coagulation pathway.(b)
Classification. Class II (performance standards).

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Image /page/0/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features the department's name in a circular arrangement around an emblem. The emblem consists of a stylized human figure with three faces, representing the department's focus on health and well-being. The text reads "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA".

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

March 16, 2016

Instrumentation Laboratory Co. Ms. Heather L. Harvey Regulatory Affairs Specialist I 180 Hartwell Road Bedford, MA 01730

Re: K160445

Trade/Device Name: HemosIL Silica Clotting Time Regulation Number: 21 CFR 864.7925 Regulation Name: Partial thromboplastin time tests Regulatory Class: Class II Product Code: GFO Dated: February 16, 2016 Received: February 18, 2016

Dear Ms. Harvey:

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

1

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 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 regulation (21 CFR Part 801), 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" (21CFR 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 yours.

Leonthena R. Carrington -S

Leonthena R. Carrington, MS, MBA, MT(ASCP) 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) K160445

Device Name HemosIL Silica Clotting Time

Indications for Use (Describe)

HemosiL Silica Clotting Time is intended for the detection of Lupus Anticoagulants in human citrated plasma on the IL Coagulation Systems by the use of screen) and confirmatory (SCT Confirm) reagents sensitized to phospholipid dependent antibodies.

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

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

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Image /page/3/Picture/0 description: The image shows the logo for Instrumentation Laboratory. The logo consists of a stylized "W" shape in shades of green and blue, followed by the text "Instrumentation Laboratory" in a dark gray sans-serif font. Below the company name, in a smaller font size, is the text "A Werfen Company".

510(k) Summary

The submission meets the criteria for a Special 510(k) under the FDA guidance "The New 510(k) Paradigm -Alternate Approaches to Demonstrating Substantial Equivalence in Premarket Notifications"(March 20, 1998).

| Submitter's Information | Instrumentation Laboratory (IL) Co.
180 Hartwell Road
Bedford, MA 01730, USA | |
|----------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|
| Contact Person | Heather L Harvey, Regulatory Affairs Specialist I
Phone: 781-861-4549
Fax: 781-861-4207
Email: hharvey@ilww.com | |
| Preparation Date | March 8, 2016 | |
| Device Trade Name | HemosIL Silica Clotting Time | |
| Regulatory Information | Classification: | Class II |
| | Regulation No.: | 21 CFR 864.7925 |
| | Common Name: | Activated Partial Thromboplastin |
| | Panel: | Hematology (81) |
| | Product Code: | GFO |
| Predicate Device | HemosIL Silica Clotting Time
510(k) No.: K050221 | |
| Device Indications for Use /
Intended Use | HemosIL Silica Clotting Time is intended for the detection of Lupus
Anticoagulants in human citrated plasma on the IL Coagulation
Systems by the use of screening (SCT Screen) and confirmatory (SCT
Confirm) reagents sensitized to phospholipid dependent antibodies.
For in vitro diagnostic use. | |
| Device Description | The HemoIL SCT assay, consisting of SCT Screen and SCT Confirm, is
intended to simplify and standardize the detection of Lupus
Anticoagulants (LA) in clinical evaluations. SCT Screen is poor in
phospholipid making it sensitive to LA. The additional amount of
phospholipid in SCT Confirm neutralizes LA to give shorter clotting
times.
Silica Clotting Time in the presence of calcium, directly activates the
intrinsic pathway of coagulation. SCT Screen and SCT Confirm are
therefore unaffected by factor VII deficiencies or inhibitors. | |

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Comparison to Predicate:

The HemosIL Silica Clotting Time insert sheet is being updated to remove the current Heparin interference references in the Summary and Principle section and the Limitations/ Interfering Substances section based on current guidance H60-A Laboratory Testing for the Lupus Anticoagulant; Approved Guideline (April 2014), with the associated references added to the Bibliography section. There is no change to the assay itself.

The submission meets the criteria for a Special 510(k) based on the following:

  • No change in indications for use or intended use
  • No change in operating principle
  • . No change to stability claims or to storage instructions
  • No change to reagent preparation
  • . No change to specimen collection and preparation
  • . No change to formulation or materials
  • No change to data reduction software
  • No change to test parameters
  • No change to calibration
  • No change to quality controls

Following is a description of the similarities and differences between the currently marketed HemosIL Silica Clotting Time (K050221) and HemosIL Silica Clotting Time with the insert sheet modifications:

Similarities
ItemPredicate (K050221)Modified Device
Indications for UseHemosIL Silica Clotting Time is intended
for the detection of Lupus
Anticoagulants in human citrated
plasma on the IL Coagulation Systems by
the use of screening (SCT Screen) and
confirmatory (SCT Confirm) reagents
sensitized to phospholipid dependent
antibodies.Same
MethodologyClotting Time in the presence of reagentsSame
AnalyzersACL TOP® Family
ACL Futura/ACL Advance
ACL ELITE®/ELITE PRO 8/9/10000Same
Sample TypeCitrated Plasma SamplesSame

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Comparison to Predicate (Cont.):

Differences
ltemPredicate (K050221)Modified Device
Insert Sheet
Summary and Principle
SectionSilica Clotting Time in the
presence of calcium, directly
activates the intrinsic pathway of
coagulation. SCT Screen and SCT
Confirm are therefore unaffected
by factor VII deficiencies or
inhibitors. Heparin interference
up to 0.4 U/mL is neutralized by
polybrene. Using a ratio of
screen and confirm allows the
SCT to be insensitive to warfarin
treated samples.Silica Clotting Time in the presence
of calcium, directly activates the
intrinsic pathway of coagulation.
SCT Screen and SCT Confirm are
therefore unaffected by factor VII
deficiencies or inhibitors. Using a
ratio of screen and confirm allows
the SCT to be insensitive to
warfarin treated samples. Per CLSI
Guideline H-60, patient samples
containing heparin may exhibit
falsely prolonged clotting times
which could lead to incorrect
results.
Insert Sheet
Limitations/ Interfering
Substances SectionSCT Screen/SCT Confirm results
on the ACL Futura/ACL Advance
and ACL ELITE/ELITE PRO
8/9/10000 are not affected by
bilirubin up to 30 mg/dL,
triglycerides up to 500 mg/dL
and Heparin up to 0.4 U/mL. Do
not use hemolyzed samples.
SCT Screen/SCT Confirm results
on the ACL TOP Family are not
affected by bilirubin up to 30
mg/dL, triglycerides up to 850
mg/dL, UF Heparin up to 0.5
U/mL and LMW Heparin up to
1.0 U/mL. Do not use hemolyzed
samples.
LA assays based on different
properties appear to be more or
less sensitive to certain
subgroups of LAs. Therefore at
least two screening assays, based
on different properties, should
be performed before the
possibility of LA is excluded.SCT Screen/SCT Confirm results on
the ACL Futura/ACL Advance and
ACL ELITE/ELITE PRO 8/9/10000 are
not affected by bilirubin up to 30
mg/dL, triglycerides up to 500
mg/dL. Do not use hemolyzed
samples.
SCT Screen/SCT Confirm results on
the ACL TOP Family are not
affected by bilirubin up to 30
mg/dL, and triglycerides up to 850
mg/dL. Do not use hemolyzed
samples.
Per CLSI Guideline H-60, patient
samples containing heparin may
exhibit falsely prolonged clotting
times which could lead to incorrect
results. LA assays based on
different properties appear to be
more or less sensitive to certain
subgroups of LAs. Therefore at
least two screening assays, based
on different properties, should be
performed before the possibility of
LA is excluded.

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Conclusion:

HemosIL Silica Clotting Time, with the modified Summary and Principle and Limitations/ Interfering Substances insert sections, is substantially equivalent to the legally marketed predicate device FDA cleared under K050221.