Sir, Diagnosing myelodysplastic syndrome (MDS) poses a peculiar challenge as they mainly present as cytopenia(s), which can occur due to a myriad of hematological and nonhematological factors. On a routine complete blood count (CBC) flagged for cytopenia(s), evaluating neutrophilic dysplasia on light microscopy suffers from a multitude of problems such as pH of the stain, quality of staining, time gap in preparation of smear, interobserver variation, and morphological alterations encountered due to secondary causes such as drugs, nutritional, toxin. There is no single parameter or test available to diagnose MDS, and so an extensive workup is required. Apart from battery of tests required, there are other morphologic overlaps present which may further complicate the problem such as megaloblastic anemia (MA) and few subtypes of myeloproliferative neoplasm (MPN). MA cases can present with pancytopenic blood picture with dyspoiesis noted in one or more lineages, similar to that noted in early MDS patients, making the early diagnosis of MDS cases difficult. The macrocytosis in MA can be obscured by concomitant disorders that in themselves cause microcytosis although the leukocyte abnormalities are preserved, resulting in masked MA [1]. Another differential of macrocytosis is MDS, which can be suspected by the presence of hypogranular neutrophils and monocytosis. Thus, in such cases, peripheral smear alone is not of much help, and further invasive tests such as bone marrow examination and cytogenetics needs to be carried out. MPN, on the other hand, usually can be differentiated from MDS and MA cases morphologically, however, with few overlaps, as in cases of primary myelofibrosis in fibrotic phase, MDS/MPN group which includes chronic myelomonocytic leukemia (CMML), atypical CML, juvenile myelomonocytic leukemia, and MDS/MPNU. They may have some clinical, laboratory, or morphologic findings at the time of initial presentation that support a diagnosis of MDS more than MPN. One or more of the other lineages may exhibit ineffective proliferation so that such cases may present with cytopenia(s) as well [2]. Such cases can present as a challenge and need to be differentiated from early cases of MDS. Neutrophil dysplasia is a feature seen in MDS as well as in CMML, thus making it difficult for NEUT-X and NEUT-Y values to differentiate them [3]. As MA is also associated with structural abnormalities in RBC and WBC as seen in MDS, they were also included in the study to evaluate its possible role in NEUT-X and NEUT-Y We evaluated the role of parameters NEUT-X and NEUT-Y (Sysmex XE-2100; Sysmex corporation, Kobe, Japan) in detecting neutrophil dysplasia in suspected MDS, MA, and MPN cases. NEUT-X and NEUT-Y are the latest parameters for neutrophil structural and maturation, NEUT-X is the direct measurement of side scatter diffraction, corresponding to channel number, and is representative of the internal structure of the neutrophils. It correlates with hypogranularity of neutrophils and when taken into consideration with anemia is suggestive of an underlying MDS. NEUT-Y is the direct measurement of the fluorescence intensity [1]. This study included four groups: control, MDS, MPN, and MA group with the aim to compare the NEUT-X and NEUT-Y values among each group as well as to record whether these two parameters have any relationship between each other in individual groups. The control group includes 66 cases which came for routine check up with no complaints or comorbidities, 30 cases diagnosed as MDS, 56 cases of MPN, and 16 cases of MA. The cases were collected over a period of one and a half years (March 2012–August 2013). Inclusion criteria in the study were as follows: • All the cases were diagnosed using multiparametric approach