A 79 year old women has sepsis secondary to pyelonephritis. On examination, temp 38.9 C, BP 90/50 mmHg, HR 110/min, and RR 18/min. she has bleeding at phlebotomy sites and around her intravenous access insertion and many ecchymosis on her arms and legs. Hemoglobin 9 mg/dl Partial 49 sec thromboplastin time Platelet count 60,000/ul D-dimer Elevated Prothrombin 17 sec Fibrinogen Reduced time Peripheral blood smear shows many fragmented erythrocytes and diminished platelets. Which of the following is the most likely cause of her bleeding disorder?