Myelodysplastic/ myeloproliferative overlap syndrome with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T) is a rare myeloid neoplasm showing myelodysplastic and myeloproliferative features. With extremely raised platelets, possibility of acquired Von Willebrand and risk of hemorrhage is increased. With this quandary in mind, a descriptive case and a discussion of available treatments ensues

A 63 year old patient with chronic lymphocytosis and neutropenia is described. A bone marrow biopsy showed a markedly hypercellular specimen with an interstitial and intrasinusoidal lymphoid infiltrate. Immunohistochemistry and immunophenotyping identified these as LGLs. With paucity of erythropoiesis diagnosis of LGL leukemia with pure red cell aplasia is reached.