Bilateral macular hemorrhage in a patient with COVID-19

Purpose: We report a case of a patient with a known hereditary spherocytosis who developed a bilateral macular hemorrhage in concurrence with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related respiratory syndrome. Observations: Blood tests showed severe hemolytic anemia. Interestingly, the peripheral blood smear demonstrated a mixed pathogenesis of the hemolytic process (cold-agglutinin-mediated and non-immune-mediated due to spherocytosis). Conclusions and importance: We argue that SARS-CoV-2 could have triggered the hemolytic process, which led to retinal hemorrhages due to endothelial anoxia from the low oxygen carrying capacity.