Platelet disorders Quiz: Ace Your Exams

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A 28-year-old woman presents to the emergency department due to fever, headache, malaise, and skin discoloration in the lower extremities. The symptoms began around 8 hours ago. Past medical history is noncontributory, and her only medication is a combined oral contraceptive pill. Temperature is 38.9°C (102.1°F), pulse is 90/min, respirations are 20/min, and blood pressure is 128/76 mmHg. Physical exam shows jaundiced skin, conjunctival pallor, and dark purple spots on the bilateral lower extremities. Laboratory testing is obtained, and results are shown below.  

 Laboratory value   Result  Reference Range 
 Hematologic   
 Platelet count  50,000/mm3   150,000-400,000/mm3 
 Hemoglobin  9.5 g/dL  12-16 g/dL 
 Haptoglobin  8 mg/dL  41-165 mg/dL 
 Blood, plasma, serum   
 Creatinine  1.0 mg/dL  0.6-1.2 mg/dL 
 Blood urea nitrogen  10 mg/dL  7-18 mg/dL 
 Lactate dehydrogenase (LDH)  360 U/L  45-90 U/L 
 Total bilirubin  4 mg/dL  0.1-1 mg/dL 
 Direct bilirubin  0.3 mg/dL  0.0-0.3 mg/dL 
   
Which of the following processes is most likely abnormal in this patient? 

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