Hereditary orotic aciduria is an exceedingly rare autosomal recessive disorder and can result in significant and irreversible developmental delay if not treated promptly. Typically, this disease process presents with progressive lethargy, failure to thrive, and megaloblastic anemia. Most commonly presenting before one year of life. We report a case found in an 11-month-old child who presented with incidental neutropenia and normocytic anemia in an otherwise healthy child.