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Background: Liver disease is frequently missed as the cause for a patient's thrombocytopenia., Aim: To evaluate the role of liver disease in causing thrombocytopenia within a tertiary hospital., Design: A hospital-based retrospective study., Methods: Analysis of medical records of outpatients and inpatients with a platelet count <100 × 10(9)/l seen at St Mary's Hospital, London in October 2011, was conducted. Cause for thrombocytopenia was determined in each case and patients with liver disease were analysed further looking at factors associated with their low platelet count., Results: In total, 223 patients were included in this study, 109 of them were outpatients and 114 were inpatients. The mean age was 57.1 years (range 22-106), 64% male and 36% female. Liver disease was the cause for thrombocytopenia in 58% of outpatients. Overall, 92 patients with liver disease were identified; cirrhosis and/or splenomegaly were present in 78%, a further 8% were on interferon therapy. Thrombocytopenia was not explained by the extent of liver disease in 8%, significantly more in hepatitis C than other causes of liver disease (P < 0.05). Factors correlating with low platelet count in patients with liver disease were spleen size (P < 0.05) and serum bilirubin (P < 0.001). There were none, or mild abnormalities only in liver function tests in 19 patients with liver disease-associated thrombocytopenia., Conclusion: Liver disease should be considered in all patients with an unknown cause of thrombocytopenia. Advanced liver disease does not have to be present for thrombocytopenia to develop. All patients with unexplained thrombocytopenia should be evaluated to see if liver disease is present, even when liver function tests are normal.