12 year old girl with moderate pancytopenia, marked hypocellular marrow (<10%) with reduced trilineage hematopoiesis, but no evidence of malignancy. Family history is significant for father who passed away of AML at age 32 years and sibling with thrombocytopenia. Telomere length shows very low telomere length in all populations analyzed (<1% percentile as expected for her given age) and genetic analysis revealed a TERC mutation. Overall this is consistent with Dyskeratosis Congenita.