American Society of Hematology (ASH) ITE Practice Test 2026 - Free Hematology Practice Questions and Study Guide

In hepatic sequestration crisis, red cells become trapped in the liver, causing a sudden fall in hemoglobin, potential hypovolemia, and marked liver enlargement. The goal is to rapidly restore circulating blood and oxygen delivery while removing the sickled cells driving the sequestration. Exchange transfusion is the best treatment because it quickly replaces a large portion of the patient’s sickled red cells with normal donor cells and lowers the percentage of HbS, which halts ongoing sequestration and improves hepatic blood flow. Splenectomy isn’t the acute solution for hepatic sequestration and is reserved for recurrent splenic sequestration or other indications; platelet transfusion doesn’t address the red cell problem; iron chelation is for chronic iron overload, not an acute crisis. While simple transfusion can raise hemoglobin, it doesn’t remove HbS and may not adequately reverse the sequestration, making exchange transfusion the preferred approach in this scenario.