Between 2019 and 2021, the American Society of Hematology (ASH) developed clinical guidelines for managing sickle cell disease (SCD), covering acute pain, acute neurological events, and other complications. However, these guidelines lacked implementation strategies for incarcerated individuals, a vulnerable group with unique challenges. In 2024, an ASH special panel of SCD and carceral health experts convened to address acute SCD care in custody settings, emphasizing timely access to emergency care, including acute management for acute strokes, pain management, and fever evaluation. The ASH special panel recommended pre-arranged emergency plans for transfer to specialized facilities, continuity of care with SCD specialists, and adherence to community-level care standards. Limitations included insufficient population data and absent chronic care guidelines. The ASH special panel urged that future ASH guidelines address SCD management tailored to carceral settings to reduce morbidity and ensure equitable care.