A 6-year-old child with sickle cell disease presents with sudden-onset severe pain in hands and feet, fever, and pallor. Hb drops from 8 g/dL to 4.5 g/dL rapidly. The spleen is not palpable. The MOST likely crisis and nursing priority is:

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Nursing QUESTION #9269

Question 1

Vaso-occlusive (painful) crisis; pain management
Aplastic crisis (due to Parvovirus B19); urgent blood transfusion✔️
Splenic sequestration crisis; splenectomy preparation
Hemolytic crisis; exchange transfusion

Correct Answer Explanation

Sickle Cell Disease — Types of Crisis:

Crisis	Features	Management
Vaso-occlusive (Painful)	Most common; bone/joint pain, dactylitis (hand-foot syndrome in young children), fever	IV fluids, analgesia (NSAIDs → opioids), O₂
Aplastic Crisis	Parvovirus B19 infects erythroid precursors; reticulocytopenia; severe anemia; spleen not enlarged	Urgent blood transfusion
Splenic Sequestration	Blood pools in spleen; massive splenomegaly; hypovolemic shock; age <5 yrs	IV fluids, blood transfusion, splenectomy
Hemolytic Crisis	Accelerated hemolysis; jaundice; often with G6PD deficiency	Identify trigger, transfuse if severe

Key clue: Parvovirus B19 temporarily shuts down erythropoiesis → reticulocytes drop to near zero → Hb falls dramatically. The spleen is already infarcted by age 5 (autosplenectomy) in sickle cell, so not palpable.

Priority nursing action: Arrange urgent blood transfusion, monitor Hb, SpO₂, vital signs closely.

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