ANSWER: (A) Factor II deficiencyREF: Mastery of Surgery by Josef E. Fischer, K. I. Bland, 5th edition Part I page 90, Saint-Frances guide: clinical clerkship in outpatient medicine. Page 434 8; 235, Harrison 17th ed table 59-4See APPENDIX-50 below for "BLE EDIN G/C O AG U L ATI ON DISORDERS" and APPROACH TO A PATIENT WITH BLEEDING DISORDER APPENDIX - 50BLEEDING/COAGULATION DISORDERSTable from Mastery of Surgery by Josef E. Fischer, K. I. Bland, 5th edition Part I page 90, http://en.uikipedia.org/wiki/ Bleeding_diathesisConditionProthrombinTimePartialThromboplastinTimeBleedingTimePlateletCountAspirinNormalNormalProlongedNormalCongenital afibrinogenemiaProlongedprolongedProlongedNormalDisseminated intravascular coagulationProlongedprolongedprolongedDecreasedEarly Liver failureProlongedNormalNormalNormalEnd-stage Liver failureProlongedprolongedprolongedDecreasedHaemophilia A (Factor 8}NormalProlongedNormalNormalHaemophilia B (Factor 9) Christmas diseaseNormalProlongedNormalNormalParahemophelia (factor 2,5,10)ProlongedProlongedNormalNormalFactor 7 deficiencyProlongedNormalNormalNormal! ThrombocytopeniaNormalNormalProlongedDecreasedBernard-Soulier syndromeNormalNormalProlongedDecreasedGlanzmann s thrombastheniaNormalNormalProlongedNormalUremiaNormalNormalProlongedNormalVitamin K deficiency or warfarinProlongedProlongedNormalNormalVon Willebrand diseaseNormalNormalProlongedNormalAPPROACH TO A PATIENT WITH BLEEDING DISORDER Obtain PT/ PTT and Platelet count Increased PT, Normal PTTNormal PT,Both PT &Both PT & PTT normalIncreased PTTPTT increasedPlatelet count* Early DIC* Liver disease* Warfarin therapy* Mild Vitamin K deficiency* Factor 7 deficiency* Coagulation factor deficiency* Coagulation factor inhibitor* Antiphospholipid antibody* Heparin therapy* Severe DIC* Severe liver disease* Warfarin overdose* Severe vitamin K deficiency* Factor 2, 5,10 deficiency* Heparin therapy> 90,000/pL Do Bleeding time< 90,000/uL ThrombocytopeniaSee extension of table below Do bleeding timeNormal bleeding timeIncreased bleeding time* Deficiency of inhibitors of fibrinolysis* Dysfibrinogenemia* Factor 13 deficiencyPlatelet dysfunctionAcquiredInherited* Severe renal disease* Severe liver disease* Myeloploreferative disorder* Autoantibodies* Paraprotenemia* DIC* vWD* Bernard Soulier disease* Glanzmann thrombasthenia