Thrombotic Thrombocytopenic Purpura (TTP): This condition is characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, neurological symptoms, and fever. The presence of retinal hemorrhage and hemolytic anemia in a previously healthy individual makes TTP a strong consideration due to its potential for causing microvascular thrombi that could lead to retinal hemorrhages.

Hemolytic Uremic Syndrome (HUS): Similar to TTP, HUS involves microangiopathic hemolytic anemia and thrombocytopenia but is more commonly associated with renal failure. While less likely to cause retinal hemorrhage directly, the systemic nature of the disease could potentially lead to such complications.
Sickle Cell Disease: Although typically diagnosed in childhood, some cases might not be identified until adulthood, especially if the individual has a milder form like sickle cell trait or HbS/beta+ thalassemia. Sickle cell disease can cause retinal hemorrhages due to sickling of red blood cells within the retinal vessels and can also lead to hemolytic anemia.
Systemic Lupus Erythematosus (SLE): SLE is an autoimmune disease that can affect multiple systems, including the hematologic and ocular systems. It can cause hemolytic anemia and, less commonly, retinal hemorrhages due to vasculitis or thrombocytopenia.

Disseminated Intravascular Coagulation (DIC): A condition characterized by both widespread clotting and bleeding, which can lead to hemolytic anemia and potentially retinal hemorrhage. It is crucial to identify and treat the underlying cause of DIC.
Malignant Hypertension: Severe hypertension can cause retinal hemorrhages and, if associated with renal disease, could also contribute to hemolytic anemia. The potential for rapid progression to end-organ damage makes this a critical diagnosis not to miss.
Leukemia: Certain types of leukemia, particularly acute leukemias, can cause retinal hemorrhages due to thrombocytopenia or leukemic infiltration of the retina. Hemolytic anemia can also occur, especially in the context of lymphoproliferative disorders.

Atypical Hemolytic Uremic Syndrome (aHUS): A rare condition similar to HUS but without the typical diarrheal illness trigger. It can cause microangiopathic hemolytic anemia and potentially retinal complications.
Paroxysmal Nocturnal Hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells (hemolytic anemia), bone marrow failure, and the potential for thrombotic events, including possibly retinal hemorrhages.
Antiphospholipid Syndrome: An autoimmune disorder that can cause blood clots in arteries and veins, potentially leading to retinal vascular occlusions and hemorrhages, along with hemolytic anemia in some cases.