Context: Megaloblastic anemias are hematological disorders in which nuclear maturation lags behind the cytoplasmic maturation. Thrombocytopenia in megaloblastic anemia is because of ineffective thrombopoiesis in some studies and hypoproduction in some studies. Objective was to study the spectrum of clinicohematological features in megaloblastic anemia & comparative bone marrow aspiration study ofthrombocytopenia secondary to megaloblastic anemia due to hyper-destruction or hypoproduction. Aims: To understand the clinico-hematological spectrum of Megaloblastic anemia and associated megakaryocytic alterations. Methods and Material:100 cases of thrombocytopenia were included in the study. Bone marrow findings in 35 cases ofthrombocytopenia of megaloblastic etiology was compared with 40 cases of marrow proven hypo productive thrombocytopeniaand 25 cases of hyper destructive thrombocytopenia. Results: Most common age group presenting with megaloblastic anemia was 20-30 years,with M:F ratio 1.4:1. Most common complaints were fatigue and generalised weakness. 14.28% of patients had shown normal in number of megakaryocytes, 57.14% of patients had shown increased number 28.57% had shown decrease in number of megakaryocytes. Dysplastic megakaryocytes were seen in 43.75%, 26.25% & 30% of cases of megaloblastic anemia, acute leukaemia and immune thrombocytopenic purpura respectively. Conclusions: Both hypoproduction and ineffective thrombopoiesis are the underlyingmechanisms in megaloblastic thrombocytopenia as evidenced by marrow findings. We conclude that megaloblastic thrombocytopenia is to be included as separate category apart from hypo proliferative and hyper destructive groups. The presence of dysplastic megakaryocyte should not prompt interpretation of myelodysplastic syndromes and should always be correlated with patient’s clinico hematological parameter.

Keywords: Hypo-Production; Hyper-Destruction; Megaloblastic Anemia.