Platelet disorders Quiz: Ace Your Exams

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A 63-year-old woman comes to the emergency department complaining of shortness of breath and oral mucosal bleeding for the last 3 days. Past medical history is notable for type II diabetes mellitus and chronic kidney disease. The patient often forgets to take her diabetes medications and missed her last two dialysis appointments. The patient’s temperature is 37.2°C (98.9°F), pulse is 114/min, respirations are 22/min, and blood pressure is 144/78 mmHg. Diffuse crackles are heard in the bilateral lungs. Petechiae are observed on the oral mucosa. 3+ pitting edema is present in the bilateral lower extremities. Laboratory testing is obtained, and results are shown below.  
 
 Laboratory value  Result  Reference Range 
 Hematologic   
 Platelet count  190,000/mm3   150,000-400,000/mm3 
 Hemoglobin  14.3 g/dL  12-16 g/dL 
 Mean corpuscular volume (MCV)  84 fL  80-100 fL 
 Blood, plasma, serum   
 Creatinine  6.2 mg/dL  0.6-1.2 mg/dL 
 Blood Urea Nitrogen (BUN)  76 mg/dL  7-18 mg/dL 
 Coagulation studies   
 Prothrombin time (PT)  10 seconds  11-15 seconds 
 Activated partial thromboplastin time (aPTT)  32 seconds  25-40 seconds 
 Bleeding time  15 minutes  2-7 minutes 
   
This patient’s petechiae are likely secondary to which of the following? 

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