Erythropoietin is approved to increase Hgb in patients undergoing dialysis. It usually must be given with supplemental iron. Patients with renal failure are anemic because erythropoietin production by the kidney is impaired.
A 25 year old woman is noted to have excessive bleeding and marked ecchymosis on her extremities the first day following delivery of a normal healthy baby boy. The patient denies any history of bleeding problems in the past and denies any family history of bleeding disorders. Some routine labs are obtained which reveal the following:
| platelet count | 175 x 109/L | (150 - 450 x 109/L) |
| Hgb | 10.5 g/dl | (12 - 14 g/dl) |
| PT | 13 sec | (11 - 13.5 sec) |
| aPTT | 54 sec | (25 -35 sec) |
A 50:50 mixing study is performed with normal plasma and patient plasma and after mixing the aPTT does not correct. Which of the following are possible etiologies for this patient's disorder?