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