Background:Myelodysplastic syndrome (MDS) is a broad array of hematological conditions defined by peripheral cytopenia, dysplastic hematopoietic progenitors, normal or hypercellular or hypocellular bone marrow, and a high risk of transition to acute myeloid leukemia.Case Report:During a regular follow-up, a 59- year-old female patient presented to our hospital with complaints of fatigue and a severe headache. A complete blood count was performed, and it was reported that the patient had pancytopenia, which was persistent. Iron, folic acid, and vitamin B12 levels in the blood were extremely low, while LDH and ferritin levels were extremely high. A biopsy revealed that the patient had hypercellular bone marrow with dyspoiesis of the cells, excess blasts in immunohistology, and a 5-q deletion in karyotyping. The patient was then diagnosed with myelodysplastic syndrome with rare hypercellular characteristics.Conclusion:Blood transfusions and immunomodulating medications like azacytidine or decitabine are the treatments. Regular monitoring of hematological symptoms is needed to prevent the progression of the disease.