Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 15 2 2021 04 11 132 134 Tahereh Gholipour Department of Clinical Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran Alireza Sadeghi Department of Internal Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Padideh Oghab Department of Oncology and Hematology, Isfahan University of Medical Sciences, Isfahan, Iran Pegah Farrokhi Department of Clinical Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran Azadeh Moghaddas Department of Clinical Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran 2019 11 23 2019 12 14 Megaloblastic anemia is a common disorder with various manifestations. Of the many causes, cobalamin or folate deficiency can eventuate into megaloblastic anemia. It can lead to pancytopenia and mild to moderate splenomegaly, but massive splenomegaly rarely seen in this situation. We describe a 39-year-old woman with marked enlargement of the spleen and pancytopenia that was found to have megaloblastic anemia. The splenomegaly and blood count resolved 4 months after initiation of vitamin B12 therapy. It is important to know massive splenomegaly may occur in megaloblastic anemia, and although it is rare, bur can reversible with early treatment. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1211 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/1211/876