An intensive care unit rapid response team is called to evaluate a hospitalized -year-old female for acute respiratory distress and severe agitation. The patient was admitted four days ago for an elective laparoscopic cholecystectomy, which was completed without surgical complications. Since admission, she has been receiving subcutaneous enoxaparin for deep venous thrombosis prophylaxis. Her medical background includes two spontaneous abortions in her twenties and a history of a false-positive rapid plasma reagin (RPR) test noted during a pre-employment screening five years ago.
On current evaluation, temperature is (), blood pressure is mmHg, pulse is /min, and respiratory rate is /min. Oxygen saturation is on room air, necessitating non-invasive positive pressure ventilation. Physical examination demonstrates diffuse coarse crackles bilaterally. Skin inspection reveals a striking reticular, violaceous pattern over her bilateral thighs and lower abdomen. She is notably oliguric over the past hours.
Urgent laboratory investigations reveal:
| Laboratory Parameter | Patient's Result | Reference Range |
|---|---|---|
| Hemoglobin | g/dL | g/dL |
| Platelets | /mm | /mm |
| Leukocytes | /mm | /mm |
| Creatinine | mg/dL | mg/dL |
| Lactate dehydrogenase | U/L | U/L |
| Prothrombin time (PT) | seconds | seconds |
| Partial thromboplastin time (PTT) | seconds | seconds |
| Fibrinogen | mg/dL | mg/dL |
A peripheral blood smear demonstrates schistocytes per high-power field. Portable chest radiography displays diffuse, bilateral alveolar opacities.
Which of the following is the most likely diagnosis explaining this patient's rapid clinical deterioration?
- Catastrophic antiphospholipid syndromeAnswer
- BThrombotic thrombocytopenic purpura
- CDisseminated intravascular coagulation
- DHeparin-induced thrombocytopenia
- EAtypical hemolytic uremic syndrome