Small is NOT beautiful in 2014: a candidate biomarker of the year? Having just awarded the peripheral blood eosinophil count Thorax's biomarker of the year for 2013 we are now presented with another often ignored peripheral blood cell component as a potential candidate for the 2014 award. Michelle Harrison and colleagues (see page 609) show in a retrospective analysis of 1343 patients hospitalised with COPD lung attacks that a raised blood platelet count is an independent predictor of mortality over the following year. This might be expected to be due to increased vascular deaths, or secondary to the known association between ventilatory failure and thrombocytosis. However, careful analysis suggested a more complex and interesting link between thrombocytosis and mortality, perhaps involving chronic inflammation. What is particularly noteworthy about this study is that patients taking anti-platelet therapy with aspirin or clopidogrel had reduced mortality suggesting that the platelet count might be a biomarker of risk that can be reduced – and any biomarker which does not lead to clinical action and benefit cannot enter our competition. The authors are appropriately cautious about their findings and call for prospective randomised controlled trials. …