<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 30-year-old woman presents to the emergency department in a state of confusion and disorientation that started this morning. She is accompanied by her husband who says that she has been unwell for about one week. She has been complaining of fatigue. Her husband says that this morning, she also complained that her urine was dark red in color and that there were some red spots over her legs. He did notice some changes in her level of consciousness that worsened over time and he decided to bring her in today. She does not have a significant medical history. Physical examination shows petechiae over her arms and legs. She is conscious but drowsy and disoriented and unable to answer the physicians questions appropriately. Her temperature is 38.3C 100.9F, blood pressure is 160100 mm Hg, pulse rate is 90min, and respiratory rate is 20min.Laboratory studies show:Hemoglobin 10 gdLLeukocyte count 9,000mm3Platelet count 30,000mm3Bleeding time 10 minProthrombin time 12 sActivated partial thromboplastin time 30 sD-dimer 0.4 mgL normal 0.5 mgLSerum fibrinogen 350 mgdL normal 200400 mgdLSerum bilirubin indirect 2.2 mgdLSerum creatinine 1.5 mgdLSerum LDH 1,010 ULBased on her history, and her physical and laboratory findings, which of the following is the most likely pathophysiology for her presentation?? A: Systemic activation of blood coagulation, B: GPIIbIIIa deficiency and failure of platelet aggregation, C: E. coli-mediated endothelial damage and formation of microthrombi, D: Decreased ADAMTS13 causing platelet adhesion and formation of microthrombi, E: Antiplatelet antibodies,  <response>: This is a clinical case scenario describing a 30-year-old woman presenting with confusion, disorientation, fatigue, dark red urine, petechiae, fever, elevated blood pressure, thrombocytopenia, prolonged bleeding time, normal coagulation tests, elevated bilirubin and LDH. The key findings are:- Thrombocytopenia - low platelet count- Prolonged bleeding time - Normal coagulation tests - ruling out disseminated intravascular coagulation- Petechiae - small hemorrhages in skin- Elevated LDH - hemolysis This presentation is most consistent with thrombotic thrombocytopenic purpura TTP. TTP is characterized by systemic microvascular thrombosis due to severely deficient activity of the von Willebrand factor-cleaving protease ADAMTS13. This leads to platelet aggregation and thrombi formation. The other options can be ruled out:- Systemic activation of coagulation would cause prolongation of PTPTT. - GPIIbIIIa deficiency would not cause thrombocytopenia or hemolysis.- E. coli infection would not cause isolated thrombocytopenia.- Antiplatelet antibodies would not cause microangiopathic hemolytic anemia.D: Decreased ADAMTS13 causing platelet adhesion and formation of microthrombi 