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: morphine / latex / vancomycin hcl/d5w / pepto-bismol attending: chief complaint: transfer from hospital for melena. major surgical or invasive procedure: egd . blood transfusion, platelet transfusion history of present illness: 59 yo f with a h/o hep c cirrhosis, breast ca, pancytopenia thought to be to hypersplenism p/w melena x 4 days. pt with large, black, tarry stools for the past four days. presented to hospital last night. found to have hct 19, plt of 9, anc 400, inr 1.3. o/n received 5 units prbcs and a six pack of plts. also placed on protonix and octreotide drips. after fourth unit of prbcs and plts: hct 24, plt count 15. also given vitamin k 10 mg x2 at osh, no repeat inr. . pt transferred to for further management. . on ros: pt denies n/v. mild diffuse abdominal pain for months. c/o b/l upper abd/lower chest pain occuring with exertion x 2 days. pain non-radiating, associated with mild sob, lasts a few minutes. past medical history: # hcv secondary to blood transfusion diagnosed in . # cirrhosis since , still followed by dr. . # status post portocaval shunt in . # variceal bleed in . # last admit with confusion and uti. # multiple admissions with encephalopathy and anasarca. # history of vaginal bleeding. status post d&c and ablation. # obesity. # lower extremity cellulitis. # mrsa. # pancytopenia thought secondary to increased spleen. # scoliosis as a teenager, status post surgery. # breast cancer social history: lives with her daughter who is a and granddaughter. died 9 years ago. no alcohol. quit tobacco 25 years ago (smoked 2ppd for 1 yr). no iv drug use. family history: no history of liver disease. physical exam: temp 98 n bp 109/44 pulse 72 resp 17 o2 sat 98 ra gen - alert, no acute distress heent - extraocular motions intact, anicteric, mucous membranes mildly dry neck - no jvd, no cervical lymphadenopathy chest - clear to auscultation bilaterally cv - normal s1/s2, rrr, 5/6 sem throughout precordium radiating to carotids abd - soft, nondistended, diffusely tender, palpable liver edge at 8cm below costal border, normoactive bowel sounds extr - 1+ pitting edemato ankles b/l. venous stasis changes. 2+ dp pulses bilaterally neuro - alert and oriented x 3, cranial nerves intact, upper and lower extremity strength 5/5 bilaterally, sensation grossly intact pertinent results: 11:47pm ck(cpk)-45 11:47pm ck-mb-notdone ctropnt-<0.01 11:47pm hct-24.1* 11:47pm plt count-32*# 07:26pm pt-15.8* ptt-43.2* inr(pt)-1.4* 05:34pm glucose-154* urea n-17 creat-0.6 sodium-137 potassium-3.7 chloride-101 total co2-15* anion gap-25* 05:34pm ck(cpk)-50 05:34pm ck-mb-notdone ctropnt-<0.01 05:34pm calcium-8.2* phosphate-3.4 magnesium-2.3 05:34pm wbc-0.6*# rbc-2.73* hgb-8.6* hct-23.3* mcv-85# mch-31.7 mchc-37.2* rdw-15.9* 05:34pm plt count-21*# 05:34pm gran ct-300* . egd impression: normal no varices normal fundus no portal gastropathy or varices in antrum fresh blood seen oozing from very mildly erythematous mucosa. erythema and congestion in the antrum and pre-pyloric region compatible with gastritis (thermal therapy) the area of gastritis was of mild severity and did not look classic for gave. normal bulb d2 and d3 with no blood and bile seen . ct chest/abd/pelvis on impression: 1. interval development of a new liver lesion in segment 7 of the liver, measuring 1.7 cm. this is concerning for metastatic disease. 2. asymmetric breast tissue within the right breast likely represents patient's known cancer, correlate with mammography or clinical history. 3. cirrhosis, splenomegaly and collateral formation compatible with portal hypertension. . ruq ultrasound: premilinary read: portocaval shunt patent . bone scan: brief hospital course: impression/plan: 59 yo f with h/o hep c cirrhosis, breast ca, pancytopenia, p/w with melena, s/p gib, stabilized in the transferred to the floor with . micu course: the patient was stabilized from a hemodynamic standpoint with 5 units of prbc and 6 units of platelets; she was started on an octreotide/protonix drip. she did not require any further transfusions during her admission. her melena resolved. egd showed gastritis, no active site of bleeding and no cauterization was required. at that point, the octreotide/protonix was discontinued, and she was started on protonix as well as nadolol for esophageal prophylaxis. she was transferred to the floor after 24 hours of stable hematocrit and after she had tolerated a diet. . 1. melena: pt presented with melena gastritis on egd. no varices on egd. hct was stable during hospitalization after transfusions, and on discharge, her hematocrit was 28.2 on discharge. bps stable throughout, and she did not experience any further episodes of melena. she should continue on nadolol and protonix on discharge for variceal prophylaxis, and this should be followed up with gi. . 2. shortness of breath: patient with crackles on exam, and new oxygen requirement. this is likely due to third spacing given her end stage liver disease, and although she diuresed appropriately in response to lasix, she does have moderate pleural effusions. she will be sent home on oxygen as her ambulatory saturation was 87%. her lasix was increased to 100bid on discharge which was to be continued for one week. this should help to appropriately diurese her, then she should resume her home dose of 80 . . 3. atypical chest pain: now resolved. have been due to demand ischemia from anemia. her enzymes were negative times 3 and she didnt have any ecg changes. . 4. cirrhosis/hep c: portocaval shunt in place which is patent by ultrasound. pt recently on tx list, but taken off due to breast ca. ct torso significant for new 1.7 cm liver lesion, concerning for either metastatic disease from breast ca or hcc. afp has not been elevated, however, can still have hcc - afp. will have patient follow up with dr. for further characterization of the lestion. cea was sent as well as ca /29 and ca 125. heme/onc recommends to consider colonoscopy to look for lesion. she should continue on lactulose and her home dose of lasix. . 5. pancytopenia: be secondary to hypersplenism which is evidenced on her ct. heme/onc following through hospital course and determined that she did not need a bone marrow biopsy as an inpatient. hemolysis labs showed a mild hemolytic anemia with decreased haptoglobin and increased ldh. her vitamin b12 an folate levels were normal. her retic count was very inappropriate suggesting that she may have a component of myelodysplastic syndrome, but will need to be further evaluated. she will see dr. for this as an outpatient. pt does not need additional transfusions based off of am labs and transfusion requirements. . 6. coagulopathy: inr of 1.7 currently with no bleeding. s/p 3 doses of vitamin k, and is likely due to her liver disease. . 7. breast ca: s/p r lumpectomy with local recurrence. per omr notes, pt's breast surgeon feels that mastectomy would be ideal. however, pt's hepatologist, dr. , feels that given pt's liver dx, general anesthesia is contra-indicated. pt's co-morbidities also severely limit chemo options. now also with new liver lesion on ct torso yesterday, concerning for metastatic disease vs. hcc. bone scan for staging did not show any other lesions. cea, ca /29 and ca 125 were sent out. . 8. dm: patient with good glucose control during hospitalization. was originally on a slidine scale, then when we restarted her glyburide she had several episodes of hypoglycemia. she informed us that she only takes glyburide at home when her blood sugars reach > 200. she was continued on this home regimen and only received sliding scale coverage for bs > 200 given her hypoglycemia. . 9. back pain: likely cancer, cont tylenol 3 for pain control. . 10. fen: diabetic diet . 11. code: full code, this was reconfirmed with the patient prior to discharge. . 12. comm: daughter (cell) medications on admission: glyburide calcium carbonate/vit d 600 mg nadolol 10 mg daily folate 1 mg daily spironolactone 200 mg daily ursodiol 300 mg lactulose 30 cc qid magnesium oxide 400 mg daily pantoprazole 40 mg daily fluticasone lasix 80 mg potassium cholride discharge medications: 1. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. lactulose 10 g/15 ml syrup sig: forty five (45) ml po bid (2 times a day): dispense one month supply. disp:*qs ml* refills:*2* 3. acetaminophen-codeine 300-30 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for back pain. disp:*120 tablet(s)* refills:*0* 4. nadolol 20 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 6. spironolactone 100 mg tablet sig: two (2) tablet po daily (daily). 7. lasix 40 mg tablet sig: 2.5 tablets po twice a day: please take a total of 100mg of lasix twice a day for one week, then take 80mg twice a day after that. disp:*150 tablet(s)* refills:*2* 8. oxygen-air delivery systems device sig: one (1) miscell. continuous: please use oxygen continuously . disp:*1 1* refills:*2* 9. glyburide 5 mg tablet sig: one (1) tablet po twice a day: please take if your blood sugar is greater than 200. discharge disposition: home discharge diagnosis: gastrointestinal bleeding from gastritis and low platelets. you will need to follow up with hematology/oncology regarding your low platelet count for a repeat bone marrow biopsy. . breast cancer: please follow up with your breast surgeon regarding your recurring breast cancer and treatment for this. . hepatitis c: you have hepatitis c and should be followed for this as an outpatient with dr. . . pancytopenia: in general, you have low blood counts of your platelets and your white blood cell counts. you will need follow up for this in hematology clinic. discharge condition: stable discharge instructions: please call if you notice that you continue to experience shortness of breath, chest pain, pain uncontrolled by medications. if you continue to have black, tarry stools, feel any dizziness or increasing weaness. . please use continuous oxygen by nasal cannula for decreased saturations. . please take 100mg of lasix twice a day for one week, and then after that take 80 mg of lasix twice a day for fluid overload. this will be adjusted by your primary care doctor. followup instructions: dr. (primary care doctor): (, @ 2:15pm. fax number: . dr. (breast surgery): ( , , @ 115 . dr. (hematology):(, @ 10:30am . dr. (gastroenterology): (, @ 930. . procedure: other endoscopy of small intestine diagnoses: thrombocytopenia, unspecified cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified viral hepatitis c without hepatic coma personal history of malignant neoplasm of breast unspecified gastritis and gastroduodenitis, with hemorrhage unspecified disorder of liver 

Answer: The patient is high likely exposed to