Lorretta, a 35-year-old female, is brought to the emergency department with complaints of bleeding from multiple sites, including her nose and gums. She also presents with pain and swelling in her left leg. She has a past medical history of deep vein thrombosis (DVT) and is currently on anticoagulant therapy. On examination, she has petechiae on her skin, swollen and tender left leg, and blood oozing from her IV site. Laboratory tests reveal prolonged bleeding time, decreased platelet count, elevated D-dimer levels, and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT). What is going on with Lorretta?

Choice A reason: Immune thrombocytopenic purpura (ITP) causes isolated thrombocytopenia due to autoimmune platelet destruction, leading to bleeding like petechiae. However, it does not typically cause prolonged PT/aPTT, elevated D-dimer, or DVT, making it inconsistent with Lorretta’s multi-system coagulopathy.

Choice B reason: Thrombotic thrombocytopenic purpura (TTP) involves microangiopathic hemolytic anemia, thrombocytopenia, and organ damage but typically presents with neurological or renal symptoms, not prolonged PT/aPTT or DVT. Lorretta’s coagulopathy and DVT history better align with another condition, making TTP incorrect.

Choice C reason: Hemophilia, a genetic clotting factor deficiency, causes prolonged aPTT but not thrombocytopenia, elevated D-dimer, or DVT. It primarily affects males and causes joint or muscle bleeds, not diffuse bleeding like Lorretta’s, making this an incorrect diagnosis.

Choice D reason: Disseminated intravascular coagulation (DIC) involves widespread clotting and bleeding, causing thrombocytopenia, prolonged PT/aPTT, elevated D-dimer, and petechiae. Lorretta’s DVT history and anticoagulant use may trigger DIC, with leg swelling indicating thrombosis, making this the correct diagnosis.