It is important to emphasize that MDS is rare in the pediatric population, and in a child presenting with even profound cytopenia, a non-MDS etiology is far more common than MDS. In particular, metabolic deficiencies (Vitamin B12, folate, or copper deficiency) and viral infections are relatively common, treatable and reversible causes of anemia and other cytopenias in children. Aplastic anemia (AA) is one of the key differential diagnoses, since the bone marrow is commonly hypoplastic in