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: penicillins attending: chief complaint: "black stools" major surgical or invasive procedure: blood transfusion history of present illness: 59yo m with esrd on hd, cad s/p cabg s/p stenting to lmca in , presented to the on with dizziness with black stool. . pt was in his usoh until when he returned from hd to home at 6pm. experienced nausea, ate "spicy schezuan" meal, then had abd upset and passed brown/black stools. went to bed and at mn awoke and passed black diarrhea. felt dizzy and felt that bs might be low; on way to fridge, collapsed with loc, with sudden feeling of dizziness and weakness. denies cp, palps, sob. regained conciousness and called ems. this was pt's first episode of melana. denies gerd. . pt takes aspirin and plavix. sigmoidoscopy 2mo ago was unremarkable. . while in , pt rec'd r femoral line, a-line, and 2 u prbc's. had episodal emesis trace. vitals on presentation to er: 98.4 91 104/91 10 100%fm pt noted to have st depressions on presentation. past medical history: 1. cardiac - cad s/p cabg (lima --> lad, svg --> om). - nstemi in s/p left main stent, ptca x 2. - nuclear stress test in with reversible defects in the lad and pda territories. 2. chf - h/o systolic and diastolic hr. echo showed ef 30%. 3. pvd s/p r tma. 4. dm. 5. htn. 6. hypercho. 7. esrd on hd since , to dm2. s/p insertion of rij permacath and placement of l brachiocephalic fistula. 8. h/ 4 melanoma, s/p right shoulder ressection in , no reccurence. social history: lives with mother in . 20 py smoking history but quit in . no etoh. no ivdu. family history: mother - recent stroke. physical exam: morbidly obese, well-appearing, nad, talkative, a+ox3 mmm, o/p clear eomi, perrl rrr, 2/6 sem loudest at lusb lungs cta bilaterally abd soft, distended, obese, +bs extr 2+ pitting edema bilaterally pertinent results: 10:45am wbc-16.5*# rbc-3.29* hgb-10.6*# hct-31.8* mcv-97 mch-32.3* mchc-33.4 rdw-15.3 10:45am plt count-259 10:45am neuts-80.1* lymphs-14.3* monos-4.5 eos-0.5 basos-0.6 01:23pm lactate-2.9* . 10:45am glucose-377* urea n-100* creat-8.7*# sodium-140 potassium-5.2* chloride-93* total co2-25 anion gap-27* 10:45am albumin-3.9 calcium-10.7* phosphate-3.3# magnesium-1.8 10:45am alt(sgpt)-38 ast(sgot)-26 ld(ldh)-226 ck(cpk)-57 alk phos-131* amylase-57 tot bili-0.3 . ck 57 --> --> 209 --> --> 57 ckmb 15 --> --> 5 ctnt .16 --> --> 1.14 brief hospital course: 1. gib: pt seen by gi who did not want to emergently scope pt since he was having an nstemi. he recieved 1 unit prbcs in the ed and another 2 overnight within 12 hrs of his arrival to the unit. his vitals signs remained stable and hct bumped appropriately to the mid 30's after the two units (29.8 --> 34.5). he arrived with a femoral cordis, which later was displaced, so two periperhal ivs were started. protonix iv. q6h hcts were done, and then decreased to q8 and then q12. he was called out on the morning of his first hopsital day since he was stable and was transferred to the on hd #2. the pt had no further episodes of melena in the hospital and was entirely asymptomatic. diet was adv as tolerated, and plan was for outpt egd and colonoscopy in 2-3wks. plavix and beta-blocker were held in hospital. transfusion goal was hct>30; pt did not require further transfusion. after discussion with gi, pt was discharged on aspirin and on a ppi (new) prior to the procedure. pt was instructed to hold plavix at home until the colonoscopy. . 2. nstemi: in the , ekg showed st segment depressions and twi in the lateral leads which were different from prior ekg. his troponin was 0.16 in the ed but increased 8 hours later, along with a rise in his ck and mb. these continued to climb over the next 24 hours, but plateued by the second hospital day. serial ekg's were checked which showed no new change. cardiology consult obtained in the ed; decision was to defer intervention as this was likely demand ischemia, hold plavix since he had been 1 yr out form his stnet placement. pt placed on tele with no events and he never had chest pain or other anginal symptoms. on the floor, pt had several brief episodes of asymptomatic bradycardia to 30's with increased ectopy. an ekg showed no changes. echo showed: ef > 60%. no as, no ar. mild pa htn. suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. . 3. esrd: renal consult obtained in ed did not find a need for emergent hd. pt had hd on icu day 1. pt's home hd is tu/th/sat. . 4. dm: on home regimen with good control. . 5. hyperchol. increased lipitor to 40qd. . 6. proph: ppi, oob . 7. pt discharged to home with very close follow-up: pcp, , gi medications on admission: insulin 70/30, 30qam 30qpm aspirin 325 nephrocaps lisinopril 10 lipitor 10 plavix 75 tums lopressor 5 discharge medications: 1. pantoprazole sodium 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* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po qd (once a day). 3. atorvastatin calcium 40 mg tablet sig: two (2) tablet po qd (once a day). disp:*60 tablet(s)* refills:*0* 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. lisinopril 10 mg tablet sig: one (1) tablet po qd (once a day). disp:*0 * refills:*0* 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 7. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po qd (once a day). 8. insulin 70/30 70-30 unit/ml suspension sig: as directed units subcutaneous twice a day: take 20 units in am and 20 units in pm. discharge disposition: home discharge diagnosis: 1. gi bleed 2. diabetes mellitus 3. hypertension 4. elevated cholesterol 5. coronary artery disease 6. history of myocardial infarction 7. end stage renal disease on hemodialysis discharge condition: good discharge instructions: call or return if you develop chest pain, shortness of breath, lightheadedness, or dizziness. call or return if you develop nausea, vomiting, abdominal pain, black stools or bloody stool. * please do not take your plavix until you have either spoken with dr. or had your colonoscopy and spoken with the gastroenterologist. * you will receive receive a prescription for protonix, which is important after your gi bleed. followup instructions: 1. follow-up with your primary care physician 1 week. 2. follow up with your cardiologist dr. . please call for an appointment. 3. follow-up with a gastroenterologist for an outpatient colonoscopy in two weeks. call . 4.provider: , m.d. where: center phone: date/time: 10:00. md procedure: hemodialysis transfusion of packed cells diagnoses: subendocardial infarction, initial episode of care pure hypercholesterolemia congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypotension, unspecified old myocardial infarction hemorrhage of gastrointestinal tract, unspecified personal history of malignant melanoma of skin chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to