<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 49-year-old woman is brought to the emergency department by her daughter because of increasing arthralgia, headache, and somnolence for the past week. She has a history of systemic lupus erythematosus without vital organ involvement. She last received low-dose glucocorticoids 2 months ago. Her temperature is 38.6 C 101.5 F, pulse is 80min, respirations are 21min, and blood pressure is 12980 mm Hg. She is confused and disoriented. Examination shows scleral icterus and ecchymoses over the trunk and legs. Neurological examination is otherwise within normal limits. Laboratory studies show:Hemoglobin 8.7 gdLLeukocyte count 6,200mm3Platelet count 25,000mm3Prothrombin time 15 secondsPartial thromboplastin time 39 secondsFibrin split products negativeSerumBilirubinTotal 4.9 mgdLDirect 0.5 mgdLA blood smear shows numerous fragmented red blood cells. Urinalysis shows hematuria and proteinuria. Which of the following is the most likely diagnosis?? A: Immune thrombocytopenic purpura, B: Disseminated intravascular coagulation, C: Hemolytic uremic syndrome, D: Thrombotic thrombocytopenic purpura, E: Glanzmann thrombasthenia,  <response>: This is a clinical vignette describing a 49-year-old woman with systemic lupus erythematosus SLE presenting with arthralgia, headache, somnolence, fever, confusion, icterus, ecchymoses, anemia, thrombocytopenia, prolonged PTT, fragmented RBCs on smear, and hematuriaproteinuria. The key findings are:- Known history of SLE autoimmune disorder- Fever, confusion - suggests an acute flareexacerbation - Thrombocytopenia and anemia - suggests hematologic involvement- Fragmented RBCs on smear - suggests microangiopathic hemolytic anemia - Prolonged PTT - suggests coagulopathy- Negative FSPs - rules out DIC- Hematuriaproteinuria - suggests renal involvementBased on the constellation of symptoms, thrombocytopenia, MAHA, and renal involvement, the most likely diagnosis is thrombotic thrombocytopenic purpura TTP.D: Thrombotic thrombocytopenic purpura 