Hyperreactive malarial splenomegaly (HMS) is common in many tropical areas and particularly affects women of reproductive age. It is associated with anaemia which can be debilitating in patients already compromised by anaemia due to poor nutrition and pregnancy. The course of the disorder in pregnancy is commonly punctuated by episodes of haemolytic anaemia which can be life-threatening to the mother and cause increased fetal morbidity and loss. Management of the chronic state consists of lifelong anti-malarial therapy supplemented by haematinics. Blood transfusions may be required to treat episodes of severe haemolysis.