Megaloblastic anemia (MA) is a common disorder with varied manifestations. It generally results in mild to moderate splenomegaly which is due to sequestration of macrocytic erythrocytes in spleen. Massive splenomegaly is generally seen in infections, myeloproliferative diseases, neoplasms, storage disorders or hematological conditions; but is not heard of and has rarely been reported in MA. We discuss a case of massive splenomegaly who presented with symptomatic anemia and was found to have MA. He was extensive evaluated for all other causes of massive splenomegaly which was normal. Further, after a therapeutic trial of MA he showed a regression in spleen size confirming that the massive splenomegaly was attributable to MA.

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Pregnancy is a diabetogenic state due to rise of anti insulin hormones like human placental lactogen, steroids, progesterone and glucagon. In pregnancy normal values for fasting blood sugar level and post meal blood sugar level are less than normal population by approximately 10-20 mg/dl. Universal screening is advocated for all women at 24/28 weeks. Those with high risks should be screened at initial visit and then at 24/28 weeks. Diagnostic values have changed over period of time. Pregestational diabetic patients should ideally be on insulin therapy before planning pregnancy. Long term follow up of gestational diabetes mellitus patients is must. This patient should undergo glucose tolerance test after 6 weeks of delivery and once in a year thereafter. Management of diabetes mellitus in pregnancy is a team approach.