Final answer:
The patient with anatomic soft tissue bleeding and poor wound healing, despite normal coagulation test results, likely has a deficiency in Factor XIII, as this factor stabilizes the clot and is not typically evaluated by routine coagulation tests.
Step-by-step explanation:
If a patient has anatomic soft tissue bleeding and poor wound healing with normal PT, PTT, thrombin time, platelet count, and platelet functional assay results, it indicates a deficiency in a factor that is not typically screened by these tests. Since the common pathways of coagulation (including fibrinogen, prothrombin, and factor XII) are apparently normal due to the results given, the most probable deficiency would be in a factor involved in the stabilization of the fibrin clot, which is not evaluated by routine coagulation tests. This leads us to suspect a deficiency in Factor XIII (fibrin-stabilizing factor), which is responsible for cross-linking fibrin and stabilizing the clot.
Factor XIII deficiency typically presents with normal initial coagulation tests but with poor wound healing and a tendency for bleeds to recur after initial cessation, which aligns with the patient's symptoms. It is also important to note that normal platelet count and function, as well as a lack of overproduction, rules out other common bleeding disorders.