A 2-year-old, previously healthy female is admitted to the Hematology/Oncology Service for fevers and pancytopenia. Daily fevers up to 102 degrees Fahrenheit started 1 week ago and are accompanied by cough, rhinorrhea, and congestion. She was seen by her pediatrician who diagnosed her with acute otitis media and obtained a CBC, which revealed pancytopenia so she was referred for admission. Physical exam is positive for a triangular facies, right erythematous and bulging right tympanic membrane, and a few scattered café au lait spots on her extremities. No hepatosplenomegaly is appreciated. Vital signs are stable. Weight is in the 3rd percentile and height is in the 45th percentile. Labs on admission show WBC 5.12x10(3)mcL, Hgb 9.6 g/dl, platelet count 12 x10(3)mcL, ANC 0.28 x10(3)mcL. MCV is 98.2. Basic metabolic panel, liver enzymes, bilirubin, LDH, and uric acid are normal. No blasts are present on peripheral smear.