A 42-year-old woman presents to the emergency department with a 24-hour history of weakness, fever, and intermittent seizures. She reports feeling increasingly fatigued over the past week and has noticed easy bruising and dark urine. She denies any recent diarrhea, abdominal pain, or bleeding. Her medical history is unremarkable, and she is not taking any medications. On physical examination, she appears pale and mildly jaundiced. Neurological examination reveals disorientation and focal neurological deficits during seizure episodes. Laboratory results reveal a hemoglobin of 7.5 g/dL (normal: 12–16 g/dL), platelet count of 10,000/µL (normal: 150,000–450,000/µL), creatinine of 1.5 mg/dL (normal: 0.6–1.2 mg/dL), and elevated lactate dehydrogenase (LDH) at 800 U/L (normal: 140–280 U/L). A peripheral blood smear shows schistocytes (fragmented red blood cells). Coagulation studies (PT, INR, fibrinogen) are within normal limits. What is the primary pathophysiological mechanism underlying her condition?
