Annals of Surgical Oncology

, Volume 21, Issue 13, pp 4330–4335 | Cite as

Flow Cytometric Evaluation of the Safety of Intraoperative Salvaged Blood Filtered with Leucocyte Depletion Filter in Spine Tumour Surgery

  • Naresh Kumar
  • Raymond Lam
  • Aye Sandar Zaw
  • Rishi Malhotra
  • Jonathan Tan
  • Gamaliel Tan
  • Tony Setiobudi



Intraoperative cell salvage (IOCS) has not been widely adopted in oncological surgery due to the hypothetical concern of reinfusion of malignant cells. We evaluated the feasibility of IOCS in combination with leucocyte depletion filter (LDF) in metastatic spine tumour surgery (MSTS).


Patients with known primary epithelial tumour, operated for metastatic spinal disease, were recruited. Blood samples were collected at five different stages during surgery: 2 stages from patient vein during induction and at the time of maximum tumour manipulation, 3 stages from the operative blood prior to IOCS processing, after IOCS processing, and after IOCS–LDF processing. Of the samples taken at each stage, 5 ml were analyzed for tumour cells using flow cytometry.


Of 12 patients recruited, only 11 could be finally analyzed. Flow cytometry analysis of their samples showed that 8 of 11 patients had tumour cells in the unfiltered salvaged blood. In filtered salvaged blood, the tumour cell count was zero in the majority of samples (8/11 patients), whereas three patients’ samples had a few tumour cells. The mean difference between the tumour cell quantity in the samples from the patient vein and filtered salvaged blood was significant.


IOCS–LDF was shown to be effective in removing tumour cells from the blood salvaged during MSTS. If there were any tumour cells found, the quantity was significantly less than that in the patient’s circulation. The results of this study reiterates the conclusions of our previous published work where we showed that IOCS–LDF treated blood in MSTS is safe for transfusion.


Circulate Tumour Cell Allogeneic Blood Viable Tumour Cell Epidural Abscess Allogeneic Blood Transfusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The manpower of this research was supported by National Medical Research Council, Singapore. We were awarded the grant in November 2010 to conduct a prospective study (Grant number: NMRC/NIG/1055/2011; Value of award: SGD 200,000.00; DSRB/IRB reference: 2011/00350). The laboratory procedure and consumables were supported by 2014 AOSpine East Asia Research Award. The authors thank A/Prof Gabriel Liu, A/Prof Joseph Thambiah, and Prof Hee Kit Wong for contributing their cases to the study and the Anaesthesia Unit (AU) Nurses at the NUHS and Alexandra Hospital (AH) Singapore for supporting the study by managing the IOCS machine and the LDF system.

Conflict of interest



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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Naresh Kumar
    • 1
  • Raymond Lam
    • 1
  • Aye Sandar Zaw
    • 1
  • Rishi Malhotra
    • 1
  • Jonathan Tan
    • 1
  • Gamaliel Tan
    • 2
  • Tony Setiobudi
    • 2
  1. 1.Department of Orthopaedic Surgery, NUHS Tower Block, Level 11National University Health SystemSingaporeSingapore
  2. 2.Department of Orthopaedic SurgeryAlexandra HospitalSingaporeSingapore

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