Recently, microaneurysm (MA) detection has attracted a lot of attention in the medical image processing community. Since MAs can be seen as the earliest lesions in diabetic retinopathy, their detection plays a critical role in diabetic retinopathy diagnosis. In this paper, we propose a novel MA detection approach named multifeature fusion dictionary learning (MFFDL). The proposed method consists of four steps: preprocessing, candidate extraction, multifeature dictionary learning, and classification. The novelty of our proposed approach lies in incorporating the semantic relationships among multifeatures and dictionary learning into a unified framework for automatic detection of MAs. We evaluate the proposed algorithm by comparing it with the state-of-the-art approaches and the experimental results validate the effectiveness of our algorithm.