Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: heparin agents attending: chief complaint: nstemi/dic major surgical or invasive procedure: none history of present illness: the patient is an 84 yo male w/pmh of cad s/p cabgx3 on at center, ckd, htn who presented initially to the center on with several days of fatigue and decreased appetite. on admission to center bun/cr 80/3.9; plt 35, h/h 9.4/28.5. there was originally concern for obstruction, a foley was placed with 500 cc uo. ua was notable for trace protein, ketones, bacteria, wbc, rbc. renal us was negative for lesions or hydronephrosis. he was started on d5ns at 75 cc/hour and given one dose of albumin 250 cc. a tte was done with ef 40-45%. his k was noted to be 6.0 so kayexylate was given. he was given 500 mg diuril prior to transfer to the . . the patient's micu course was complicated by thrombocytopenia with elevated fdp/d-dimer thought likely to represent dic, troponin elevation with ? nstemi, renal failure, and possible saphenous vein donor site infection. . past medical history: past medical history: htn cad s/p cabg x 3 - lima to lad, rsvg to plv/om1) on - post-op complicated by atrial fibrillation treated with amiodarone hyperlipidemia ckd - baseline 1.3-1.7 prostate ca - s/p xrt gerd pulmonary nodule - stable x 2 years . psh: 1)cabg as above 2)s/p r cea 3)s/p ccy 4)s/p l tkr 5)s/p hernia repair social history: the patient is married and lives with his wife. has 2 sons. is a wwii veteran. he lives in ri with his wife currently, retired meat cutter family history: nc physical exam: vitals: t- 95.5 bp: 122/50 hr: 58 rr: 22 o2: 98% on 2l . general: patient is an elderly male, appears tired but in nad, very pleasant heent: ncat, eomi. + right neck well healed scar s/p previous cea. neck: ej distended. jvp appprox 10cm chest: few scattered high pitched expiratory wheezes. mildly decreased bs at left base but otherwise cta. no rales appreciated. healing sternotomy scar with dressing below sternotomy c/d/i. non-tender cor: rrr, normal s1/s2. no m/r/g appreciated abdomen: soft, non-tender, nd. +bs extremity: right le with significant area of erythmea over medial aspect of leg, warm. non-tender, no area of fluctuance appreciated. + ecchymosis over right foot. 2+ pedal edema bilaterally. dp 1+ bilaterally, feet warm. pertinent results: 11:23pm blood wbc-8.4 rbc-2.99* hgb-8.9* hct-26.0* mcv-87 mch-29.7 mchc-34.1 rdw-14.3 plt ct-50* 10:05am blood wbc-7.0 rbc-3.49* hgb-10.5* hct-30.9* mcv-88 mch-30.1 mchc-34.1 rdw-14.7 plt ct-149* 11:23pm blood neuts-82.2* lymphs-6.6* monos-6.4 eos-4.6* baso-0.2 11:23pm blood pt-16.0* ptt-35.2* inr(pt)-1.5* 11:23pm blood plt ct-50* 10:05am blood plt ct-149* 11:23pm blood fibrino-65* d-dimer-6202* 11:23pm blood fdp-320-640* 12:00pm blood fdp-40-80 11:23pm blood glucose-106* urean-75* creat-3.6* na-137 k-4.9 cl-102 hco3-25 angap-15 10:05am blood glucose-125* urean-29* creat-1.6* na-133 k-4.7 cl-98 hco3-25 angap-15 11:23pm blood alt-41* ast-42* ld(ldh)-399* ck(cpk)-173 alkphos-139* totbili-0.7 10:05am blood alt-28 ast-24 ld(ldh)-427* alkphos-120* totbili-0.6 11:23pm blood ck-mb-22* mb indx-12.7* ctropnt-1.18* 07:00am blood ck-mb-13* mb indx-8.8* ctropnt-1.88* 06:45am blood ck-mb-notdone ctropnt-3.09* 07:25am blood ck-mb-notdone ctropnt-3.28* 11:23pm blood hapto-85 07:25am blood tsh-3.1 01:46pm blood hbsag-negative hbsab-positive hbcab-negative hav ab-positive igm hav-negative 11:23pm blood psa-<0.1 01:46pm blood hcv ab-negative 10:15am blood heparin dependent antibodies- positive ecg: : nsr, 60, nml axis. incomplete rbbb. no acute st changes. non specific tw changes v1-v6. . imaging: . : portable chest - impression: 1. cardiomegaly with small left-sided pleural effusion. 2. no signs for focal consolidation or pulmonary edema. . : right leni - negative for dvt, no drainable fluid collection . : echocardiogram left atrium: mild la enlargement. right atrium/interatrial septum: mildly dilated ra. left ventricle: normal lv wall thickness, cavity size, and systolic function (lvef>55%). normal regional lv systolic function. no lv mass/thrombus. no resting lvot gradient. no vsd. right ventricle: normal rv chamber size and free wall motion. paradoxic septal motion consistent with prior cardiac surgery. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. aortic valve: three aortic valve leaflets. moderately thickened aortic valve leaflets. minimally increased gradient c/w minimal as. no ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. mild thickening of mitral valve chordae. calcified tips of papillary muscles. no ms. trivial mr. normal lv inflow pattern for age. tricuspid valve: mildly thickened tricuspid valve leaflets. normal tricuspid valve supporting structures. no ts. mild to moderate +] tr. normal pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. normal main pa. no doppler evidence for pda pericardium: no pericardial effusion. . mra kidney- findings: there is no evidence of thrombosis within either the right or left renal vein, or within the ivc. note is also made of bilateral pleural effusions as well as a fluid- filled duodenal diverticulum arising from the 3rd portion of the duodenum. multiplanar reformatted images reviewed at the time of interpretation support these findings. impression: no evidence of renal vein thrombosis. . b leni: no evidence of left lower extremity deep vein thrombosis. thrombosis of the right greater saphenous vein, not reaching to the junction with the common femoral vein. . brief hospital course: patient is a n 84 yo male with cad s/p cabg on with course complicated by thrombocytopenia/dic, arf, and troponin leak. issues as follows: . #. thrombocytopenia/hit - pt with persistent thrombocytopenia since immediately post-op, concerning for postbypass thrombocytopenia vs hit. hit ab strongly positive. low fibrinogen and elevated coags consistent with dic per hematolgy who followed that patient. per, heme, likely combination of hit (heparin induced thrombocytopenia) and dic (disseminated intravascular clotting) of unclear etiology (may be secondary to graft site cellulitis). started on argatroban and coumadin. once inr within recommended therapeutic range (4-5 per heme), argatroban was discontinued. an inr 4 hours later was x, which was in therapeutic range for the patient's chronic needs for afib and hit. patient will need to be on coumadin for 3 months per heme. prior to discontinuation of coumadin, will need to have hit antibodies tested to ensure resolution. if still positive, will need to continue on coumadin and should have hematology follow-up. he should avoid all heparin products in the future. . he received cryoprecipitate, 4u ffp, 2u prbcs and 1u platelets during his stay in the micu. . #. cad - patient had a troponin leak and was followed by cardiology. troponin rose from 1.18 to 3.28 throughout course. initially unclear significance in setting of recent cabg and arf. however, decision made to treat for nstemi for which patient is on aspirin and beta-blocker, held acei and heparin given acute renal failure and ? hit. echo with preserved ef and no wall motion abnormalities. plan for medical management for now, ? cath in future with further improvement in creatinine. patient had post-op afib, initially on amiodarone, but that was discontinued per cardiology since returned to and stayed in sinus rhythm. a tsh was within normal limits. medically managed with asa, beta blocker, statin, although statin continued at lowered dose given elevated liver function tests. . #. pump - echo reveals preserved ejection fraction, no wall motion abnormalities. clinically patient appeared mildly volume overloaded with elevated jvd, peripheral edema and complaints of mild orthopnea. was gently diuresis with lasix after renal function returned to what appears to be the patient's baseline with minimal improvement in his symptoms. still with bilateral pedal edema and may need to be continually diuresis based on clinic appearance. . #. renal failure - initial consideration given to hus/ttp as above but less likely now. followed by nephrology: unclear etiology although may be consistent with atn. this may be post-op complication although no reported episode of hypotension, but at risk as on pump. no eos in urine or other evidence of cholesterol emboli. creatinine slowly improved and patient had adequate urine output daily. mri of kidneys showed no renal vein thrombosis. . #. hypoxia - initially required 2l and appeared to be appears mildy volume overloaded as explained above. was weaned off oxygen and then maintained saturations of 95-97 on room air. had no recurrent episodes of hypoxia but did develop some wheezing and feelings of lung congestion 2 days prior to discharge. wheezing and symptoms improved with albuterol/ipratropium nebs. placed on standing nebs and eventually transitioned to spiriva and albuterol inhalers with resolution of symptoms. . # lle edema - new on exam . dependent edema vs. heart failure. again, very mildly clinically volume overloaded on exam. gently diuresed above with with no resollution of lle edema. compression stocking placed on left leg. had bilateral lower extremity ultrasounds which were negative for deep vein thrombosis on the left with postive clot in the right greater saphenous (graft site for cabg). . #. atrial fibrillation - episode of afib post-op by report but in sinus throughout this hospital admission. continued on betablocker. avoid amiodarone given thrombocytopenia per cardiology. anticoagulation may not be needed long term if atrial fibrillation was isolated in response to cabg surgery. this will need to be reassessed on an outpatient basis. . #. cellulitis - patient afebrile throughout admission without significant leukocytosis, however, right medial knee was erythematous and appeared infected clinically. evaluated by surgery who drained what they thought was a nonpurulent hematoma. patient was initially treated with zosyn and vancomycin but coverage was switched to oral ciprofloxacin when wound cultures returned with pansensitive serratia. wound continued to improve. wound care per surgery recs: ace wrap to right lower extremity and wick placement to graft site wound. . patient is being discharge to a rehabilitation center for physical therapy and continued post-operative care. medications on admission: aspirin 81 mg daily amiodarone 200 mg daily pepcid 20 mg daily colace 100 mg lopressor 12.5 mg lovastatin 40 mg daily tylenol #3 prn discharge disposition: extended care facility: the holiday discharge diagnosis: non st elevation myocardial ischemic event disseminated intravascular coagulation heparin induced antibiodies graft site cellulitis discharge condition: stable discharge instructions: you were admitted to the hospital with fatigue and poor appetite and were found to have acute renal (kidney) failure and some changes in your blood counts (low platetelets and red blood cells). you also had elevated cardiac enzymes (lab tests that are markers of heart muscle damage) which may have been related to your recent heart surgery or to additional heart damage from being so ill. you were medically treated as if you had new heart damage and did very well. your kidney function improved but you will need to discuss this with your primary care physician. however, your platelet level continue to drop after given an anticoagulant medicine called heparin. you were tested and found to have antibodies in your blood to heparin which was making your platelet count fall. you were then switched to a different medicine, argatroban, and are being bridged to coumadin. you will need to be on coumadin for 3 months and should have blood work done prior to discontinuation of coumadin to make sure that those antibodies have resolved. you should avoid all heparin products in the future. your lab tests have been imroving and are now within the normal range. you also had an infection of the graft site of the inside of your right knee which was opened to allow it to drain by the surgery service. you were started on an antibiotic, ciprofloxacin, and should continue that for a full 10 day course. you should also continue to keep your right leg in the ace bandage until seen by your heart surgeons at center in follow-up. you were had some swelling of your lower legs while in the hospital which may be related to not being very physically active or to poor heart function. you were given a diuretic to help get rid of some of the fluid. discuss the need for future diuretic therapy with your primary care physician. you also complained of some shortness of breath during your admission, which was improved with medications. you are being discharged with spiriva and albuterol inhalers. please take them as prescribed. please take all medications as prescribed. contact a physician for fever > 101.5, worsening redness, swelling, or pus draining from your incision site, chest pain, palpitations, dificulty breathing, loss of conciousness, lightheadedness, or any other concerns. followup instructions: with your primary care physician 1-2 weeks. md procedure: transfusion of packed cells transfusion of other serum transfusion of platelets diagnoses: subendocardial infarction, initial episode of care esophageal reflux other postoperative infection acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of malignant neoplasm of prostate aortocoronary bypass status chronic kidney disease, unspecified other and unspecified hyperlipidemia defibrination syndrome cellulitis and abscess of leg, except foot 

Answer: The patient is high likely exposed to