There are multiple hemorrhages in the right fundus, some of which have a white center. There are also hemorrhages in the left fundus, though details are obscured by a vitreous hemorrhage.
There are many causes of white-centered hemorrhages, also known as Roth Spots. The most common include anemia, thrombocytopenia, diabetes, leukemia, HIV infection, bacteremia, fungemia, hypertension, and subacute bacterial endocarditis. Our patient had chronic lymphocytic leukemia diagnosed 14 years ago. She was recently hospitalized for anemia and thrombocytopenia and received transfusions.
Roth spots form when there is a rupture of a retinal capillary, resulting in extrusion of whole blood. This invokes the coagulation cascade, which results in a platelet-fibrin thrombus that is responsible for the pale appearance at the center of the hemorrhagic lesion.