Acute myeloid leukemia is a malignant disorder of the normal hematopoietic cells which results into symptoms due to absence of normal blood cells and those due to infiltration of leukemic cells to different tissues. syndrome is the most common genetic disorder in humans. It occurs as a result of a genetic disorder which is Trisomy 21. Another genetic disorder called GATA 1 mutation may occur in Down syndrome children. GATA1 is essential for erythroid (red blood cell) and megakaryocytic development. These two genetic abnormalities lead to development of a unique disorder named transient leukemia also known as transient myeloproliferative disorder. There are many theories to explain the role of Trisomy 21 and GATA1 mutation in development of TMD. It should be noted that TMD resolve spontaneously without treatment. It must be differentiated from acute leukemia which require intense treatment regimen by age of onset, peripheral blood & bone marrow picture.