A myelodysplastic syndrome with excessive blasts (MDS-EB1, 8% blasts in bone marrow). On admission, there was haemolysis, anaemia, thrombopenia and presence of fragmentocytes, leading to the initial suspicion of a thrombotic microangiopathy. The leukocytes display dysplasia beyond the promyelocytic stage, with abnormal maturation of the nucleus and aberrant granulation. Molecular testing revealed ASXL1 and RUNX1 mutations. In the bone marrow, dysplastic megakaryocytes and a large number of erythroblasts were seen.