男，20岁。1周来发热，食欲减退，厌油腻，恶心，呕吐，尿黄，黄疸急剧上升至血清总胆红素17μmol/L，凝血酶原活动度35%。近2天出现嗜睡，烦躁不安伴牙龈出血，皮下瘀斑，肝肋下未扪及，该患者的诊断首先应想到

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