Aplastic anemia (AA) is a bone marrow failure disorder resulting in peripheral pancytopenia and marrow hypoplasia. An alternative diagnosis of hypoplastic myelodysplastic syndrome (MDS) can overlap this diagnosis but is differentiated by the presence of dysplastic progenitor cells. Since AA can be characterized as an autoimmune disease directed against hematopoietic stem cells, its presence can potentially increase susceptibility to alternate malignancies. Hypoplastic MDS, however, can present itself in an extramedullary fashion solely or as a relapse of acute myeloid leukemia resulting in symptoms similar to those described in this case study. Solid tumor malignancies may also result in abnormal blood counts, creating a wide differential diagnosis. This manuscript presents a case of untreated AA in a patient presenting later with severe abdominal bloating.