What hematologic disease is most likely contributing to her bleeding?
A 26-year-old female (G1P1) is readmitted two weeks post–vaginal delivery due to increased vaginal bleeding. She reports that the bleeding began on the tenth day after delivery and has increased in severity each subsequent day. The delivery was uncomplicated with minimal blood loss and the patient did not receive any epidural anesthesia. She has taken 200 mg of ibuprofen daily since delivery. The patient reports a medical history of iron deficiency anemia due to menorrhagia. She is adopted and does not know her family history.
Since admission, the patient has received three units of blood. The obstetrics team has ruled out a retained placental tissue and uterine atony as the cause of bleeding. Her laboratory values are as follows:
Hemoglobin 2.1 g/μL (13.7-17.5 g/dL)
Platelets 110 k/μL (161-347 k/μL)
Activated partial Thromboplastin time 40 sec (25-37 sec)
Prothrombin time 15 sec (11-17 sec)
Fibrinogen 200 mg/dL (177-466 mg/dL)