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Abstract Objective: To determine the relationship of severity of thrombocytopenia with various grades of esophageal varices in patients with cirrhosis. Study design: A cross sectional observational study. Place and duration of study:  Medicine department of Pakistan Railway General Hospital from 1st September, 2018 to 31st August, 2020. Material and Methods: The record of 100 patients with cirrhosis having concomitant thrombocytopenia and esophageal varices was retrospectively analyzed.  The information about clinical, hematological, biochemical, ultrasound and endoscopic findings was retrieved from medical record. On the basis of platelet count, four groups were made. Group I consisted of patients with a platelet count ≤ 20,000/ µl, group II 21,000-49,000/ µl, group III 50,000-99,000/ µl, and group IV 100,000- 149,000/ µl. Esophageal varices were reclassified as small and large varices group depending on the size. Correlation of thrombocytopenia with grading of esophageal varices was calculated using spearman’s correlation. Results:   Out of 100 patients, 76% had large varices and 24% had small varices. Thrombocytopenia was more severe in patients with large varices group when compared with small varices group. There was significant negative correlation between thrombocytopenia and grading of esophageal varices (r= -.691; P < 0.001). Conclusion: The severity of thrombocytopenia increased with increase in the size of esophageal varices.  Low platelet count can strongly predict large varices in patients with cirrhosis.