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: amoxicillin attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: upper endoscopy x 2 with 3 endoclips placed in the middle third of the esophagus, colonoscopy, capsule endoscopy history of present illness: 67 year old male with recent admission for gi bleed presents with recurrent rectal bleeding. the patient was admitted to with a gi bleed. an egd showed a duodenal dieulafoy lesion, which was treated with epinephrine as well as surgical clips with good hemostasis. he required a total of 15 units prbcs during that hospitalization and had stabilization of his hct at 30 upon discharge on . he visited his pcp on day of admission for dysuria and increased urinary frequency. he hadn't had a bm for two days and also denied n/v. while at the pcp, noted blood in the rectal vault and sent him to the ed. in the ed the patient had an ngt placed with fresh blood return; he was given 2 units prbc and admitted to the medical icu. past medical history: - gi bleed in setting of high dose aspirin use for sciatica - blood clot in rectum after having surgery - duodenal dieulafoy lesion as above - ? vonwillebrand disease - gi bleed due to a duodenal dieulafoy lesion, as above social history: drank several etoh jello shots this past week, but no etoh otherwise. no past of present smoking history. no ivdu. lives with his wife in community duplex. family history: daughter with disease, discovered upon profuse bleeding during tonsillectomy. no other family members have been tested. physical exam: physical exam on admission: vs: 96.3 79 128/67 14 98 @ ra gen: a+ox3, nad heent: op clear, eomi neck: supple, no lad, ? enlarged thyroid lungs: ctab heart: rrr no murmurs abd: s/nt, mild distention, +bs extr: w/wp, no edema pertinent results: laboratory tests on admission: wbc-13.0 hgb-7.7 hct-22.1 mcv-89 rdw-18.6 plt count-360 neuts-83.8* bands-0 lymphs-11.8* monos-2.6 eos-0.9 basos-0.9 glucose-113* urea n-25* creat-0.9 sodium-138 potassium-4.4 chloride-107 total co2-25 calcium-7.9* phosphate-2.8 magnesium-2.3 u/a: blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg rbc-0 wbc-0-2 bacteria-few yeast-none epi-0 laboratory tests on discharge: wbc-3.9 hgb-10.3 hct-30.0 mcv-90 rdw-16.7 plt ct-392 neuts-56.1 lymphs-32.0 monos-8.5 eos-2.6 baso-0.8 glucose-87 urean-11 creat-1.1 na-139 k-4.2 cl-104 hco3-29 alt-101 ast-59* ld(ldh)-793* alkphos-62 totbili-1.3 other tests facviii-336 vwf ag >200, vwf cof 320 tsh-7.1 free t4-1.1 hbsag-negative hbsab-positive hbcab-negative igm hav-negative hcv ab-negative parietal antibody-negative ekg: ekg: sinus rhythm. inferior t wave changes are nonspecific early r wave progression. since previous tracing, no significant change radiology: abd u/s: the right lobe of the liver appears unremarkable without evidence of focal lesions or intrahepatic biliary dilatation. the left lobe of the liver is not well seen due to overshadowing bowel gas. the gallbladder contains several sludge balls but no definite stones. there is no evidence of cholecystitis. the pancreas is not well seen due to the overlying bowel gas. the common bile duct measures 3.6 mm. the right kidney measures 10.2 cm in length. the left kidney measures 11 cm in length, and contains a 1.9 x 1.7 cm simple cyst in the interpolar region. in addition, adjacent to the simple cyst there appears to be an approx. 1.2-cm complex lesion with hyperechoic rim and isoechoic center. no significant internal doppler flow is seen. no evidence of hydronephrosis or nephrolithiasis is seen in either kidney. the spleen measures 11 cm in greatest diameter and appears unremarkable. the visualized portion of the aorta is normal in caliber. no ascites is seen. portal veins, hepatic veins, and hepatic arteries demonstrate normal doppler flow and waveforms. gi bleeding scan: no evidence of gi bleeding. mri abdomen: susceptibility artifact is demonstrated within the region due to metallic device. visualized aspects of the liver, spleen, gallbladder, and left adrenal glands, and pancreas are unremarkable. the right adrenal gland is not visualized due to susceptibility artifact from the metallic device. multiple t1 hypointense, t2 hyperintense, nonenhancing lesions are demonstrated within the left kidney, the largest which is interpolar and contains a single thin septation, this lesion measures 2 cm. a total of three cysts are seen within this kidney. there is no evidence of solid mass. there is no evidence of nodularity within the cysts. on the right, there is a tiny simple cyst, which measures 6 mm at the upper to mid kidney. visualized bowel is unremarkable. there is no lymphadenopathy or ascites. the bones demonstrate no suspicious lesions. kub: interval progression of the endoscopy capsule which now projects over the mid descending colon. several smaller capsule fragments appear unchanged in position within the mid right abdomen. no evidence of obstruction or free intraperitoneal air brief hospital course: 67 year old male with a recent gi bleed due to a duodenal dieulafoy lesion (s/p sclerotherapy ) presents with brbpr and hct 22. 1) gastrointestinal bleed: the patient underwent an egd , which showed friability and nodularity in the middle third of the esophagus with a visible venous vessel that was oozing. 3 clips were placed; no bleeding was noted from the previously treated dieulafoy's lesion. a non-bleeding stomach body erosion was also noted. given the patient's hematocrit was stable following transfusion, he was transferred to the general medical floor. on , he had increased frequency of maroon stool; a repeat egd was performed which was negative. he subsequently underwent a bleeding scan , which was without evidence of bleeding. on , he underwent a colonoscopy, which showed diverticulosis of the descending colon and sigmoid colon, but no source of bleeding. a repeat colonoscopy is recommended in 5 years. he then underwent a capsule endoscopy on , the results of which are pending at the time of discharge. the patient will be contact by the gastroenterology service within 2 weeks with the results. at the time of discharge, the patient's hematocrit is stable without further evidence of gastrointestinal bleeding. 2) acute blood loss anemia: the patient's hematocrit was 22.1 on admission; over the course of his hospital stay, he was transfused 6 units of blood (the last ). at time of discharge, the patient's hematocrit was stable at 30. the patient was continued on a multivitamin and folate. 3) hemolysis: the patient was noted to be hemolyzing (high ldh, hapto <20, elevated bilirubin). direct comb's test was positive, with antibody indentification of ant-c, e, and jka. the hematology service was consulted, who felt this was consistent with and intravascular allo-ab hemolytic anemia. he most likely had an acute hemolytic reaction to emergency release blood he received in the ed on (1 unit was c positive, 1 was jka positive). the patient's hemolysis labs gradually trended down, although haptoglobin remained <20; given repeat direct comb's test was negative, hematology did not recommend further work-up at this time. the patient should inform all his physicians that he has a history of acute hemolytic reaction. 4) possible disease: given positive family history, the patient had a factor viii, vwf cof, and vwf checked, all of which were elevated, not consistent with vw disease. 5) transaminitis: the patient's alt peaked at 198, ast 202, an elevation that may have been related to mild liver hypoperfusion at the time of his gi bleed. a ruq ultrasound (see results) showed gallbladder sludge without stones and normal doppler studies. hcv antibody was negative, hbv panel was consistent with prior immunization, and hav igm was negative. the patient's iron/tibc ratio was >50% (116/173), but ferritin was not significantly elevated at 105 to suggest iron overload. the patient's lfts were trending down at time of discharge (alt 101, ast 59). these should be monitored as an outpatient, and further work-up (such as liver biopsy) pursued at the discretion of the patient's pcp. 6) vitamin b12 deficiency: the patient was treated with im vitamin b12 for 5 days then transitioned back to oral regimen. an intrinsic factor antibody was negative. 7) nausea, vomiting, diarrhea: on the evening of , the patient developed watery diarrhea, nausea and vomiting. a kub showed no evidence of obstruction, with the endoscopy capsule having passed into the large bowel. c. diff toxin assay (-) x 1. the patient's symptoms resolved within 24 hours, indicating that they may have been due to a gastroenteritis. 8) h. pylori: the patient was noted to be h. pylori antibody positive. he will complete a 2 week course of clarithromycin, metronidazole, and ppi. 9) leukopenia: on , the patient's wbc was 2.9, with a normal differential. this rose to 3.9 on discharge. this may have been due to a viral illness (gastroenteritis as above). the patient's wbc should be repeated as an outpatient to ensure stability. 10) renal mass: on the patient's abdominal ultrasound showed a 1.2-cm lesion in the left kidney with echogenic center and hypoechoic rim. a follow-up mri showed bilateral renal cysts, the largest on the left containing a thin septation, however, there was no evidence of suspicious solid masses and no evidence of internal nodularity. the patient should have a repeat imaging study (abd ct/mri) in 6 mos to evaluate for change in size/character. 11) enlarged thyroid: the patient had an elevated tsh, but free t4 was normal. these should be repeated once the patient has recovered from this acute episode. he should also have an outpatient thyroid ultrasound to evaluate for nodules. 12) hypertension: the patient remained normotensive off lisinopril. his blood pressure should be monitored as an outpatient and lisinopril restarted as needed by his pcp. 13) full code medications on admission: b12 2000mcg daily lisinopril 10mg daily pantoprazole 40mg discharge medications: 1. clarithromycin 250 mg tablet sig: two (2) tablet po bid (2 times a day) for 5 days. disp:*20 tablet(s)* refills:*0* 2. metronidazole 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 5 days. disp:*10 tablet(s)* refills:*0* 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 4. hexavitamin tablet sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 5. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: upper gastrointesintal bleed secondary: gastroenteritis, hemolysis, h. pyloir infection, vitamin b12 deficiency renal cysts, thyromegaly, hypertension, transaminitis. discharge condition: stable discharge instructions: 1) please follow-up as indicated below 2) please take all medications as prescribed. do not restart lisinopril until directed to do so by your primary care physician. will complete 5 more days of antibiotics to treat h. pylori 3) please come to the emergency room if you develop bleeding, lighthededness, change in your urine color, nausea, vomiting, abdominal pain, lightheadedness, diarrhea, or other symptoms that concern you. 4) you were found to have anti-c, e, and jka antibodies in your blood; please inform your physicians that you have a history of hemolytic reaction to a transfusion. followup instructions: primary care: please follow-up with your primary care physician 1 week following discharge - please discuss scheduling a thyroid ultrasound to better evaluate your enlarged thyroid gland - please discuss schedule an abdomen ct to evaluate for change in the renal cysts seen on your mri - you should have a repeat cbc (white blood cell count, hematocrit, and platelets) checked at that time to ensure stability. md procedure: other endoscopy of small intestine endoscopic control of gastric or duodenal bleeding other diagnostic procedures on small intestine diagnoses: unspecified essential hypertension acute posthemorrhagic anemia other b-complex deficiencies unspecified disorder of kidney and ureter acquired hemolytic anemia, unspecified diverticulosis of colon (without mention of hemorrhage) helicobacter pylori [h. pylori] esophageal hemorrhage dieulafoy lesion (hemorrhagic) of stomach and duodenum other specified gastritis, without mention of hemorrhage nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to