You review the history taken in the medical note.  This was a 65 year old gentleman who had presented with a 3 week history of lethargy, SOB on exertion and had noted some dark stool on occasions.   You note a previous MI and hypertension in the past medical history.

He was haemodynamically stable.

His full blood count shows:

Hb 90g/l

wbc 5.6 X 10*9

PLT 455 X10*9

MCV 82 fl

Urea was slightly elevated, with a normal creatinine

The rest of the coagulation sample was normal.

You send off a repeat coag sample, as he only has one previous coagulation screen performed over 10 years ago, which was normal. You also send extra samples which have been requested by the lab staff, incase further testing is needed!

He has not been prescribed LMWH given the suspicion of a possible bleed.

What specific quesitons will you ask the patient?

Any further findings on examination that may raise concern?

What are the possible causes for a prolonged APTT in this patient?