Review Question - QID 213432

A 4-year-old boy presents to the emergency department with a 1 hour history of severe knee pain after he bumped his knee against a door. He has no past medical history though his parents say that he seems to bruise fairly easily. His parents say that they are afraid he may have accidentally taken his grandfather's warfarin medication. On presentation, he is found to have an erythematous, warm, swollen knee. Based on this presentation, a panel of laboratory tests are ordered with the following results:

Bleeding time: 3 minutes
Prothrombin time (PT): 12 seconds
Partial thromboplastin time (PTT): 56 seconds
Mixing studies show no change in the above lab values

Which of the following is most likely the cause of this patient's symptoms?