A 26 year male presented to our department with chief complains of fatigue and history of intermittent fever. CBC reveals isolated thrombocytopenia with normal hemoglobin and Total leucocyte count. His platelet count was between 60,000 to 1 lac from last 6 months. He had a history of taking weight gaining drugs that is steroids. To rule out the cause of isolated thrombocytopenia he came to our department for bone marrow aspiration and biopsy. Bone marrow aspiration smears showed predominantly fat element and were hypocellular showing only 2 fragments . Biopsy also revealed only trabecular bone , no cells of erythroid , myeloid and megakaryocytic series were seen. It is well established that levels of marrow fat are higher in older adults with osteoporosis, defined by either low bone density or vertebral fracture. Higher levels of marrow fat in young male are known to occur in conditions of starvation , alcoholism, spinal cord injury and prolonged bed rest , conditions that are also associated with reduced bone density. Medications that increase marrow fat include glucocorticoids and thiazolidinediones(TZDs), highlighting the interconnection of bone formation and marrow fat accumulation. A decrease in BM cellularity is observed in several hematologic disorders, including aplastic anemia, hypoplastic MDS, and hypoplastic leukemia, and distinguishing one from another is not always easy [14–16]