Teaser: Young Female with Pancytopenia

A 40 year old female with past medical history of psoriasis, Crohn’s disease s/p ileocolic resection is admitted for shortness of breath and fatigue. She endorses bloody diarrhea over the past 2 weeks. Vitals are stable. Labwork reveals hemoglobin of 2, WBC 1.8, and platelets of 47K…after resuscitation she maintains her hemoglobin and no further bloody stools are noted over the next several days. Peripheral smears are negative for schistocytes and direct coombs is negative, LDH is very elevated. What is the most likely cause for her pancytopenia? (Picture above shows schistocytes just FYI — not involved in this Q) 

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