Zhang T, Li ZC, Pan ZB, Qi SQ, Tang R. Nomogram-based prediction of post-splenectomy thrombocytosis in children with hereditary spherocytosis. World J Hematol 2026; 12(1): 115355 [DOI: 10.5315/wjh.v12.i1.115355]
Corresponding Author of This Article
Ran Tang, MD, Department of Pediatric Surgery, Anhui Provincial Children’s Hospital, No. 39 Wangjiang East Road, Baohe District, Hefei 231000, Anhui Province, China. njmutr@163.com
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Hematology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 21, 2026 (publication date) through Feb 10, 2026
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World Journal of Hematology
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2218-6204
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Zhang T, Li ZC, Pan ZB, Qi SQ, Tang R. Nomogram-based prediction of post-splenectomy thrombocytosis in children with hereditary spherocytosis. World J Hematol 2026; 12(1): 115355 [DOI: 10.5315/wjh.v12.i1.115355]
World J Hematol. Jan 21, 2026; 12(1): 115355 Published online Jan 21, 2026. doi: 10.5315/wjh.v12.i1.115355
Nomogram-based prediction of post-splenectomy thrombocytosis in children with hereditary spherocytosis
Tao Zhang, Zhong-Ce Li, Zhu-Bin Pan, Shi-Qin Qi, Ran Tang
Tao Zhang, Zhong-Ce Li, Zhu-Bin Pan, Shi-Qin Qi, Ran Tang, Department of Pediatric Surgery, Anhui Provincial Children’s Hospital, Hefei 231000, Anhui Province, China
Co-first authors: Tao Zhang and Zhong-Ce Li.
Author contributions: Zhang T and Li ZC contributed equally to data acquisition and analysis as co-first authors; Pan ZB and Qi SQ assisted with data interpretation and literature review; Tang R conceptualized the study, supervised the analysis, and critically revised the manuscript. All authors reviewed and approved the final version.
Supported by Anhui Provincial Health and Wellness Scientific Research Project, No. AHWJ2024Aa30300.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Anhui Provincial Children’s Hospital (approval No. EYLL-2024-005). All procedures were conducted in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. De-identified clinical data supporting the findings of this study will be made available six months after publication and can be accessed by contacting the corresponding author via email (njmutr@163.com).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ran Tang, MD, Department of Pediatric Surgery, Anhui Provincial Children’s Hospital, No. 39 Wangjiang East Road, Baohe District, Hefei 231000, Anhui Province, China. njmutr@163.com
Received: October 16, 2025 Revised: October 24, 2025 Accepted: December 29, 2025 Published online: January 21, 2026 Processing time: 96 Days and 18.9 Hours
Abstract
BACKGROUND
Hereditary spherocytosis (HS) is the most common congenital hemolytic anemia in children, and splenectomy remains the standard treatment. However, postoperative thrombocytosis (PST) frequently occurs and may predispose patients to thromboembolic events. Despite its clinical relevance, the risk factors contributing to PST in children with HS remain inadequately defined, and reliable predictive tools are lacking. We hypothesized that specific clinical and hematological parameters could be integrated into a nomogram model to predict the occurrence of PST and thereby improve perioperative risk stratification and individualized management.
AIM
To identify risk factors for PST in children with HS after splenectomy and develop a predictive nomogram model.
METHODS
We retrospectively analyzed 230 children with HS who underwent total splenectomy at Anhui Provincial Children’s Hospital (2018 to 2025). Patients were classified into PST (n = 158) and normal platelet (n = 72) groups. Clinical features and preoperative hematological indices were collected, and postoperative platelet counts were monitored on days 6-10. Univariate and multivariate logistic regression identified independent predictors. A nomogram was constructed, and its discrimination, calibration, and clinical utility were evaluated using receiver operating characteristic curve, calibration curve, and decision curve analysis.
RESULTS
Among 230 patients, 158 (68.7%) developed PST. Univariate analysis showed associations with preoperative hemoglobin < 90 g/L (P = 0.03), reticulocyte > 6% (P = 0.001), total bilirubin > 34 μmol/L (P = 0.04), preoperative platelet count < 150 × 109/L (P = 0.02), and transfusion ≥ 10 mL/kg (P = 0.01). Multivariate regression identified reticulocyte > 6% [odds ratios (OR) = 2.46, 95% confidence interval (CI): 1.35-4.48, P = 0.003], preoperative platelet count < 150 × 109/L (OR = 1.95, 95%CI: 1.12-3.39, P = 0.02), and transfusion ≥ 10 mL/kg (OR = 1.88, 95%CI: 1.09-3.24, P = 0.02) as independent predictors. The nomogram achieved an area under the curve of 0.92 (95%CI: 0.87-0.96), with good calibration and clinical net benefit across thresholds of 0.2-0.7.
CONCLUSION
PST is frequent after splenectomy in pediatric HS. The nomogram integrating reticulocyte percentage, platelet count, and transfusion volume provides an accurate and clinically useful tool for risk prediction and individualized perioperative management.
Core Tip: Postoperative thrombocytosis is a frequent complication following splenectomy in children with hereditary spherocytosis, yet its predictors remain unclear. In this large cohort of 230 patients, we identified elevated reticulocyte count, low preoperative platelet count, and higher transfusion volume as independent risk factors. Based on these parameters, we developed and validated a nomogram with excellent discriminative power, good calibration, and strong clinical utility. This practical tool enables early risk stratification and individualized perioperative management, potentially reducing thrombotic complications and improving outcomes in pediatric hereditary spherocytosis patients undergoing splenectomy.
