A 20 years old male patient was diagnosed as hypoplastic myelodysplastic syndrome (hMDS) - refractory cytopenia with multilineage dysplasia in November 2002. He received packed blood cells, methylprednisolon and dexamethason but no persistent improvement and even worsening of the thrombocytopenia and the appearance of neutropenia were registered. Laparoscopic splenectomy has been performed in January 2003, when the platelets were approximately 15000/mm3, without intraoperative incidents. After splenectomy, no other therapy or transfusions have been applied and a slow but continuous improvement of the peripheral blood counts up to normal values has been noted. In the bone marrow, a notable increase of cellular density was registered after more than three years from splenectomy, with the persistence of the other morphological dysplastic features.