A 70-year-old patient with systemic mastocytosis (SM) received a total thyroidectomy without experiencing severe complications, according to a case study recently published in the Journal of Medicine, Law, & Public Health.
“Although the patient in this case had an uneventful postoperative course, the use of a multidisciplinary approach and careful perioperative management was key to minimising risk and ensuring a favourable outcome,” study authors said.
What is SM?
Systemic mastocytosis (SM) is a rare hematological disease characterized by mast cells that are overactive and accumulate in different parts of the body such as the bone marrow, liver, spleen, gastrointestinal tract and lymph nodes.
Special care must be taken when considering surgery for patients with SM because of the heightened risk of adverse reactions.
Read more about the SM care team
“Severe anaphylaxis caused by the release of histamine from mast cells can lead to poor postoperative outcomes, especially during general anesthesia, as the severe manifestations of anaphylaxis, such as cardiovascular collapse and bronchospasm, may potentially be the first symptoms to present,” the authors said.
The patient had a history of papillary thyroid carcinoma and atrial fibrillation and was scheduled to receive a total thyroidectomy. She had received a diagnosis of SM via gastrointestinal biopsy two years prior and was prescribed midostaurin and a protein kinase inhibitor to manage her symptoms.
Notably, the patient did not report a history of anaphylaxis, allergies or cardiac or respiratory symptoms. She had also undergone several surgeries prior to being diagnosed with SM without any complications.
Examination confirmed atrial fibrillation with normal vitals and no signs of heart failure. The patient was classified as a high risk for operative cardiovascular complications, including anaphylaxis, rapid heart rate, stroke, congestive heart failure or damage to the heart.
The patient continued receiving midostaurin throughout the perioperative period. Apixaban, which was prescribed for her atrial fibrillation, was temporarily paused.
The surgery proceeded without complications. The patient was then extubated and experienced a short episode of high blood pressure, which was treated with esmolol. As a precautionary measure, she was admitted to the intensive care unit, where she remained stable until she was discharged.
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