A patient with severe deficiency of protein C presents with purpura fulminans. What is the underlying pathophysiological mechanism leading to this condition?

A Uncontrolled activation of the coagulation cascade due to lack of inhibition of factors Va and VIIIa ✓
B Impaired fibrinolysis due to decreased plasminogen activator activity
C Enhanced platelet activation and aggregation due to increased thromboxane A2 production
D Increased expression of tissue factor on endothelial cells

Explanation

Protein C deficiency leads to uncontrolled activation of the coagulation cascade, resulting in the formation of microthrombi and subsequent tissue necrosis, as seen in purpura fulminans.

Source

New England Journal of Medicine, 2018;379:1077-1087
Hematology Hematology: Coagulation Disorders Hematology: Coagulation Disorders Hard MEDICAL Confidence: high