Chart — Hematology
Sickle Cell Crisis Comparison Chart
Four crises, four different emergencies. Pain is the common one; the other three are the ones that kill when missed — and the reticulocyte count plus the respiratory picture tell them apart.
Educational use only. Crisis management follows provider orders and protocols — this chart supports recognition and escalation. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Crises Side by Side
| Crisis | Mechanism | Presentation | Key Labs | Nursing Priorities |
|---|---|---|---|---|
| Vaso-occlusive (pain) crisis | Sickled cells obstruct microcirculation → tissue ischemia | Severe pain — back, chest, extremities, abdomen; the most common crisis and admission reason | Hgb near patient baseline; labs may be unremarkable — pain is the diagnosis | Rapid scheduled/PCA opioid analgesia (no meperidine), IV hydration, warmth, treat triggers, incentive spirometry to prevent acute chest |
| Acute chest syndrome | Vaso-occlusion/infection/fat embolism in the pulmonary circulation | Chest pain, cough, fever, hypoxia, dyspnea + new infiltrate on imaging — can evolve from a pain crisis in progress | Falling SpO₂; infiltrate on chest imaging; Hgb may drop | Escalate immediately — oxygen, analgesia that does not suppress breathing, antibiotics and transfusion/exchange per team; leading cause of death |
| Splenic sequestration | Blood pools acutely in the spleen | Rapidly enlarging, tender spleen + pallor, tachycardia, hypotension — classically infants and young children | Hgb falls fast; reticulocytes high (marrow still working) | Volume resuscitation and transfusion support emergently; teach caregivers home spleen palpation — recurrence is common |
| Aplastic crisis | Marrow temporarily stops producing — classically parvovirus B19 | Profound fatigue and pallor, often after a febrile illness; few other findings | Hgb falls with reticulocytes low — the differentiating pattern | Transfusion support until marrow recovers; protect pregnant staff/visitors from parvovirus exposure |
Escalation Triggers
• New chest pain, cough, falling SpO₂, or rising respiratory rate during any admission → acute chest syndrome workup now
• Falling Hgb + high retics + enlarging spleen → sequestration · falling Hgb + low retics → aplastic
• Fever is an emergency in functional asplenia — cultures and antibiotics per protocol, not observation
• Neuro changes raise stroke — sickle cell disease is a leading cause of childhood stroke
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with AABB (transfusion standards) · American Society of Hematology (ASH). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →