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The question
A 34-year-old construction worker collapses outdoors at midday in summer with a core temperature of 41.8 °C. Six hours after cooling, he is oozing from cannula sites. Results: platelets 41 × 10^9/L (reference 150-400), PT 22.5 s (11.0-13.5 s), APTT 54 s (25-35 s), fibrinogen 0.8 g/L (80 mg/dL; 2.0-4.0 g/L), D-dimer 18.5 mg/L FEU (below 0.5), factor V 32%, factor VII 38% and factor VIII 29% (all 50-150%), and ALT 210 U/L (below 45). The blood film shows occasional schistocytes. The coagulation results are best explained by:
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