A 24-year-old man presented with a 2-year history of recurrent epistaxis and fatigue. Laboratory workup revealed persistent pancytopenia (white blood cell count 2.23 × 10⁹/L, platelet count 54 × 10⁹/L) but consistently normal liver enzymes. An extensive hematologic investigation, including multiple bone marrow aspirations and genetic testing for Myelodysplastic syndromes (MDS), was unrevealing.
