Review Question - QID 109778

A 57-year-old man presents to the emergency department for feeling weak for the past week. He has experienced a subjective fever during this time. The patient has a medical history of IV drug use, hepatitis C, atrial fibrillation, cirrhosis, alcohol dependence, obesity, and depression. His temperature is 102°F (38.9°C), blood pressure is 157/98 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, he is noted to be fatigued with diffuse yellowing of his skin. Cardiopulmonary exam is notable for bibasilar crackles on auscultation. Abdominal exam is notable for abdominal distension, dullness to percussion, and a fluid wave. The patient complains of generalized tenderness on palpation of his abdomen. The patient is started on piperacillin-tazobactam and is admitted to the medical floor. On day 4 of his stay in the hospital, the patient is afebrile and his pulse is 92/min. His abdominal tenderness is reduced but is still present. Diffuse yellowing of the patient's skin and sclera is still notable. The nurses notice bleeding from the patient's 2 peripheral IV sites that she has to control with pressure. A few new bruises are seen on the patient's arms and legs. Which of the following is the most likely explanation for this patient's condition?