طفلة عمرها ٤ سنوات بالأنيميا المنجلية صارت فجأة شاحبة جداً وخاملة، والبطن منتفخ والطحال كبير جداً. الهيموغلوبين نزل من ٨ إلى ٤. النبض ١٦٠، والضغط ٧٨/٤٠. ما الأرجح؟

A 4-year-old with sickle cell disease suddenly becomes very pale and lethargic with a distended abdomen and a very large spleen. Hb has fallen from 8 to 4 g/dL. HR 160, BP 78/40. What is most likely?

1. An ordinary mild pain crisis
2. Splenic sequestration crisis
3. Constipation with abdominal gas
4. A mild viral infection

Answer: B) Splenic sequestration crisis. Sudden splenomegaly with falling Hb and shock indicates splenic sequestration, an emergency needing fluids and urgent transfusion; parents are taught to feel the spleen.