GPT and infection: In addition, she presented marked transaminase elevation (aspartate aminotransferase (AST) and alanine aminotransferase (ALT): 1,487 U/L and 773 U/L, respectively), coagulopathy (international normalized ratio (INR): 2.67 and fibrinogen: 159 mg/dL in the setting of ongoing bleeding), and signs suggestive of infection (fever, leukocytosis, and a urine culture positive for Escherichia coli), which created a major challenge in differentiating between sepsis, DIC, and TMA.