Antiviral therapy in hepatitis C virus (HCV) infection is limited by haematological side-effects, especially thrombocytopenia and leucopenia. The pancytopenia associated with liver cirrhosis has multifactorial causes, but hypersplenism seems to be a major contributor, especially regarding thrombocytopenia. The use of PSE as a 'Pretreatment' in order to make more patients with HCV-induced cirrhosis and pancytopenia suitable for antiviral therapy using ribavirin and pegylated interferon is a new, promising concept. The setting needs further investigation in prospective, longitudinal studies, in order to evaluate safety, define patient selection criteria, the timing between the PSE procedure and the antiviral therapy and to evaluate the long-term results. The setting needs further investigation in prospective, longitudinal studies, in order to evaluate safety, define patient selection criteria, the timing between the PSE procedure and the antiviral therapy and to evaluate the long-term results.