en Pediatric Surgery Pediatric Surgery پژوهشي Original Article <div style="text-align: justify;"><span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:2;"><strong>Objective: </strong>Splenectomy remains a definitive therapeutic option for selected pediatric immune-mediated and hemolytic disorders; however, comparative data on early postoperative hematologic and coagulation changes across different indications remain limited. Understanding these short term dynamics is important for risk stratification, complication surveillance, and perioperative management.<br> <strong>Materials and Methods:</strong> In this retrospective longitudinal study, we analyzed pediatric patients with immune thrombocytopenia (ITP), hereditary spherocytosis (HS), and thalassemia who underwent total splenectomy between 2017 and 2021 at two tertiary referral centers. Hematologic and coagulation parameters were evaluated preoperatively and postoperatively. Between group differences were assessed using ANCOVA adjusted for age and sex, while within patient changes were analyzed using paired t tests with standardized effect sizes. All analyses were conducted using R version 4.3.1.<br> <strong>Results: </strong>Thirty eight patients were included. Across all diagnostic groups, splenectomy led to rapid and statistically significant increases in platelet count, hemoglobin, RBC count, hematocrit, WBC count, and MCV (all p < 0.05), with effect sizes ranging from moderate to large. Preoperative intergroup differences in RBC indices and platelet levels diminished postoperatively, suggesting convergence toward a shared short term hematologic pattern regardless of underlying disease. Conventional coagulation measures (PT, PTT, INR) remained stable. Age and sex had minimal influence on postoperative laboratory changes.<br> <strong>Conclusions: </strong>Total splenectomy in pediatric immune mediated and hemolytic disorders produces a rapid and largely uniform hematologic improvement while maintaining short term stability of conventional coagulation markers. These findings provide clinically useful insight into immediate postoperative physiology and support future multicenter investigations to refine surveillance and risk adapted management protocols in pediatric splenectomy patients.</span></span></span></div> Hematology, Immune thrombocytopenia, Hereditary spherocytosis, Thalassemia, Splenectomy, Coagulation, Pediatrics 25 36 http://ijbc.ir/browse.php?a_code=A-10-1602-2&slc_lang=en&sid=1 Mohsen Rahmanian 100319475328460013341 100319475328460013341 No School of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran. Ebrahim Mohammadiyan Damaski 100319475328460013342 100319475328460013342 No School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Leila Ameri 100319475328460013343 100319475328460013343 No Parsian Medical Center, Mashhad, Iran. Sarah Khosropanah 100319475328460013344 100319475328460013344 No School of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran Khashayar Atghiyaei 100319475328460013345 100319475328460013345 No Department of Pediatric Surgery, Akbar Children’s Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Ali Ghasemi 100319475328460013346 100319475328460013346 No Department of Pediatrics, Sheikh Children’s Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Tahereh Sadeghi 100319475328460013347 100319475328460013347 No Department of Pediatrics, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Mahdi Parvizi mashhadi Mpmmd1983@gmail.com 100319475328460013348 100319475328460013348 Yes Department of Pediatric Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.