A 61‑year‑old retired Nassau county Police Department officer and 9/11 responder now living in Florida presents with severe, persistent thrombocytopenia (platelets ~26 K/µL), mild anemia, and borderline leukopenia, with markedly reduced megakaryocytes on bone marrow evaluation. Autoimmune panels to date have been negative. The working consideration is acquired amegakaryocytic thrombocytopenia (AATP) or a toxin‑associated marrow failure syndrome. The patient is under active he