Background: Megaloblastic anemia is a common and potentially reversible cause of anemia, particularly in developing countries like India. It results from impaired DNA synthesis, most commonly due to vitamin B12 and folate deficiency, leading to characteristic hematological and clinical manifestations. Aim: To evaluate the clinical and hematological profile of patients diagnosed with megaloblastic anemia in a tertiary care hospital. Material and Methods: This observational, descriptive, cross-sectional study was conducted on 100 patients with hemoglobin levels <10 g/dL and peripheral blood smear findings suggestive of megaloblastic anemia at P.D.U. Medical College, Rajkot, over a period of three months (August 2025 to October 2025). Clinical details including age, gender, socioeconomic status, symptoms, and dietary habits were recorded. Severity of anemia was assessed using complete blood count parameters. Patients with chronic diseases such as renal disease, malignancy, tuberculosis, and liver disease were excluded. Results: The highest incidence of megaloblastic anemia was observed in the 11–30 years age group (49%). A slight female preponderance (56%) was noted. Most patients belonged to the lower socioeconomic class (61%). Generalized weakness (92%) and pallor (88%) were the most common presenting features, followed by dyspnea (54%) and giddiness (46%). Neurological manifestations were observed in 26% of cases. A majority of patients (68%) were vegetarians. According to WHO criteria, moderate anemia was the most common severity pattern (48%), followed by mild (29%) and severe anemia (23%). Conclusion: Megaloblastic anemia remains a common and treatable condition in tertiary care settings, predominantly affecting young individuals from lower socioeconomic backgrounds. Vitamin B12 deficiency, particularly among vegetarians, appears to be a major contributing factor. Early recognition based on clinical and hematological parameters and timely vitamin supplementation are essential to prevent complications and improve patient outcomes.