Anemia is a common complication in patients with chronic kidney disease, closely related to hospitalization rate, transfusion rate, mortality rate, and other complications. Here, we report anemia related issues in an elderly male patient undergoing maintenance hemodialysis. At first, he was receiving high doses of ESA combined with Roxadustat, which kept his hemoglobin stable. Unfortunately, he got COVID-19, and after adjusting the anemia management plan, he still needed repeated blood transfusion to improve anemia symptoms. After excluding other anemia related factors, we considered that the aggravation of anemia was related to COVID-19. Then, adjust the dosage of ESA to 6000 U three times a week and use it in combination with Roxadustat at a dose of 200 mg three times a week. After 2 months, the hemoglobin level remained at 8.0-12.2 g/dL. Taken together, we reported a case of stable anemia that was aggravated after COVID-19 infection and required repeated blood transfusion, and could be corrected after reasonable program adjustment. There are many factors that affect anemia. This case shows that COVID-19 is may one of the important factors that aggravate anemia.