The worlds of biology and medicine in general, and the discipline of hematology in particular, enjoy a rich lexicon full of fascinating etymologies. The term "Pawn Ball Megakaryocytes" has been used to describe a peculiar type of abnormal cell that can be found in bone marrow samples taken from some patients with the myelodysplastic syndrome (MDS). The three-ball pawnbroker's symbol that these megakaryocytes resemble is ancient and may have derived from the insignia of the Medici family or the symbol of Saint Nicholas of Myra. The murky history of the symbol and its significance for myelodysplasia are reviewed.