This 55 year old gentleman of afro-Caribbean background and previous medical history of T2DM presented to our haematology department in early 2021 following admission with COVID pneumonitis. He was referred due to poorly controlled ET with a platelet count of 1200 x 109/l. He was currently on 2g Hydroxycarbamide and 25mg Ruxolitinib. He was originally diagnosed over 10 years prior in another country. After retrieval of his original notes it was clear that the patient have refractory disease and was currently on a trial receiving Ruxolitinib. When he first was diagnosed with ET he received peg interferon that was titrated up to 135mcg. The patient struggled with gastrointestinal side effects and his platelets at best were 900 x 109/l.