In a splenic sequestration crisis, what happens to the blood?

• A. Blood is trapped or pooled in the spleen
• B. It is unrelated to splenomegaly
• C. It improves with fluids alone
• D. Splenectomy is never used to treat it

Answer: (A)

Blood becomes trapped or pooled in the spleen during a splenic sequestration crisis. The spleen enlarges rapidly and sequesters circulating red blood cells, pulling blood from the circulation into the spleen. This causes a sudden drop in hemoglobin and can lead to hypovolemia or shock if not treated promptly. This scenario is typically seen in conditions like sickle cell disease and is directly linked to splenomegaly. Management focuses on stabilizing circulation and restoring red cell mass, usually with IV fluids and a transfusion; in recurrent cases, splenectomy or splenic-sparing options may be considered.