question: Q:A 4-year-old girl is brought to the physician because of diarrhea and vomiting for 5 days. Vaccinations are up-to-date. She appears pale and irritable. Her vital signs are within normal limits. Examination shows petechiae on her trunk and extremities. Abdominal examination shows diffuse abdominal tenderness with hyperactive bowel sounds. The remainder of the exam shows no abnormalities. Laboratory studies show:
  Hemoglobin 8 g/dL
  Leukocyte count 17,000/mm3
  Platelet count 49,000/mm3
  Serum
  Creatinine 1.6 mg/dL
  Lactate dehydrogenase 300 U/L
  Coagulation studies are normal. A peripheral blood smear is shown. Which of the following is the most likely underlying cause of these findings?"? 
  {'A': 'Acute lymphocytic leukemia', 'B': 'Immune thrombocytopenic purpura', 'C': 'Disseminated intravascular coagulation', 'D': 'Escherichia coli infection', 'E': 'Parvovirus B19 infection'},