ART4 and autoimmune thrombocytopenic purpura: When thrombocytopenia is markedly severe in contrast to end-stage liver disease (ESLD), it's essential to investigate alternative causes such as immune thrombocytopenic purpura (ITP) [3]. In patients with ESLD, B lymphocytes overproduce glycoprotein (GP) IIb/IIIa, potentially increasing the risk of developing ITP [5].