Patient description: A 53-year-old man presents with chronic HCV infection for the past 2 years. His past medical history is only significant for inguinal hernia surgery when he was 20 years old. He is on IFN (100 mg/week) plus RBV (400 mg/day) combination therapy for the past 9 months. Direct antiviral drugs were added to his treatment 6 months ago. His medical record shows previous positive HCV RNA tests as well as positive enzyme immunoassay for anti-HCV-antibodies. The recent biopsy was negative for hepatocellular carcinoma and was only remarkable for chronic inflammation compatible with a chronic viral hepatitis. There is no evidence of alcoholic liver disease, bleeding from esophageal varices, hemochromatosis, autoimmune hepatitis or metabolic liver disease. He is an alert male with no acute distress. His BP: 130/75, HR: 90/min and BMI: 27. His abdomen is soft with no ascites or tenderness. The lower extremities are normal with no edema.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Thrombocytopenia Cancer Liver Diseases Patients with history of locally advanced or metastatic solid tumor, with a plan to initiate cancer directed systemic therapy for adjuvant or palliative purposes years of age or greater Known liver disease attributed to one of the following: 1. Chronic HBV and/or chronic HCV with Cirrhosis 2. Alcoholic Cirrhosis 3. Nonalcoholic Fatty Liver Disease with Cirrhosis 4. Primary Biliary Cholangitis 5. Primary Sclerosing Cholangitis 6. Autoimmune Hepatitis 7. Hereditary Hemochromatosis 8. Wilsons Disease 9. Alpha-1 Antitrypsin Deficiency 10. Congestive Hepatopathy 11. Cirrhosis or known pre-existing liver dysfunction of unknown cause, or not otherwise specified No specific Child-Pugh Score will be required for eligibility Patients with liver involvement with primary or metastatic cancer are eligible, if the patient also has a diagnosis from list in Platelet count of < 80,000/mcL at time of enrollment, and no platelet count ≥ 80,000/mcL in the 4 weeks prior to enrollment. A platelet count ≥ 80,000/mcL in the prior 4 weeks within 72 hours of a platelet transfusion will not make a patient ineligible No prior cancer directed therapy that is cytotoxic, marrow suppressive, or has thrombocytopenia as a known common side effect in the past 12 months. a. For purposes of this study, cytotoxic/marrow suppressive systemic cancer therapy drugs will i. Nucleoside Analogue, including gemcitabine and fluorouracil ii. Carboplatin or cisplatin iii. Anthracycline iv. Alkylating agent v. Other cancer directive therapies with thrombocytopenia as a known common toxicity even if not cytotoxic b. If a patient has received cytotoxic systemic cancer therapy at any time in the past, then patients will be evaluated for myelodysplastic syndrome and leukemia prior to enrollment ECOG Performance status ≤ 2  History of immune causes of thrombocytopenia (ITP) Presence of leukemia or myelodysplastic syndrome Known bone metastases sufficient to result in at least one site of cortical bone destruction, osteolytic lesions, or osteoblastic lesions, on radiologic imaging Patients who have previously received thrombopoietin mimetics such as romiplostim, eltrombopag, etc Patients who require emergent systemic cancer therapy will be excluded Patients who require emergent radiation therapy will be excluded. a. Note: Concomitant radiation therapy with systemic cancer therapy is permitted Pancytopenia at enrollment (Hemoglobin <9 g/dL and/or Absolute Neutrophil Count < 1500/mcL). a. G-CSF and Red Blood Cell transfusions to treat anemia and neutropenia and achieve adequate hemoglobin and ANC are permitted Patients with serum sodium ≤130 mEq/L will be excluded Patients with a known bleeding disorder or platelet dysfunction will be excluded 1. Baseline Prothrombin Time (PT) that is greater than 2" above the upper limit of normal. 2. Activated Partial Thromboplastin Time (aPTT) that is greater than 3" above the upper limit of normal Patients with known genetic prothrombotic conditions (Factor V Leiden, Prothrombin 20210A, Antithrombin deficiency or Protein C or S deficiency) or history of antiphospholipid syndrome