This is a 71 year old male who presented with persistent pancytopenia.  The bone marrow aspiration and biopsy showed dysplasia in all 3 series including erythroid, myeloid and megakaryocytes. Iron (Prussian blue) stain showed >15% ring sideroblasts. Cytogenetic analysis showed abnormal male karyotype with Trisomy 8 in 50% of cells. All these features were consistent with myelodysplastic syndrome with ring sideroblasts and multilineage dysplasia.