AIIMS Raipur NO - 201…: 'Sequestration crisis' is related to:

AIIMS Raipur NO - 2019 (Shift-1)

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Raipur NO - 2019 (Shift-1)

Explanation

Sequestration crisis is a specific and acute complication of sickle cell disease.
It occurs when sickled red blood cells obstruct blood flow out of the spleen, causing a large amount of blood to become trapped there.
This leads to a rapid and severe drop in hemoglobin and circulating blood volume, causing splenomegaly, severe anemia, and potentially hypovolemic shock.
It is most common in young children with sickle cell anemia whose spleens have not yet become fibrotic (autosplenectomy) from repeated sickling events.

Option A: Pernicious anemia is a type of megaloblastic anemia caused by the inability to absorb vitamin B12. It affects the maturation of red blood cells in the bone marrow but does not cause the cells to sickle or become trapped in the spleen.
Option C: Aplastic anemia is a rare condition where the bone marrow fails to produce adequate numbers of all three blood cell types (pancytopenia). It is a problem of production, not abnormal cell shape leading to sequestration.
Option D: Iron deficiency anemia is the most common type of anemia, caused by a lack of iron. This results in small (microcytic) and pale (hypochromic) red blood cells, which do not cause sequestration crises.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Sickle Cell Anemia as background academic context rather than a clinical decision trigger.
Nurses must be able to rapidly identify the signs of splenic sequestration in a patient with sickle cell disease: sudden weakness, extreme pallor, tachycardia, and a tender, enlarged abdomen (splenomegaly). This is a medical emergency requiring immediate fluid resuscitation and blood transfusion.
Patient and family education is critical. Parents of children with sickle cell disease should be taught how to palpate for an enlarged spleen and to seek immediate medical care if they notice it, along with sudden pallor or lethargy.
What if the patient was an adult over 30? The answer would still be sickle cell anemia conceptually, but a sequestration crisis would be much less likely. By adulthood, most patients with sickle cell disease experience 'autosplenectomy,' where the spleen becomes shrunken and non-functional due to repeated infarctions, making large-scale sequestration impossible.

How to Approach the Question

First, identify the key term in the question: 'Sequestration crisis'.
Recall or deduce the meaning of 'sequestration', which implies trapping or pooling.
Analyze the pathophysiology of each anemia listed in the options.
Pernicious anemia, aplastic anemia, and iron deficiency anemia are related to problems with RBC production, maturation, or components, not a shape that causes trapping.
Sickle cell anemia is defined by abnormally shaped (sickled) red blood cells.
Logically connect the abnormal shape of sickle cells to the concept of them getting trapped or 'sequestered' in an organ with narrow passages, like the spleen.

Concept Tested & Keywords

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Harrison's Principles of Internal Medicine, 21st Edition p. 845-847