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: prochlorperazine attending: chief complaint: coagulopathy/acute blood loss anemia major surgical or invasive procedure: endoscopy history of present illness: this is a 57 yo f with question of hemochromatosis and likely alcohol induced cirrhosis with no history of varices as well as a hisory of pe on warfarin s/p gib both on and off warfin in the past who was referred to the ed for an elevated inr. she saw dr. on the day of admission for routine follow up and for evaluation of ongoing abdominal discomfort. she had labs drawn for routine follow up and for continued evaluation for liver transplant. her inr returned at 13.7 and her hct was 25.7. she was called into the ed for further evaluation. of note, she reports her inr was 2.7 two weeks ago. on questioning, the patient reports several days of antecendant malaise with increasing doe. she denies cp, palpitations, syncope, hematemesis, gerd, or melena but had been having increasing constipation with bloating and ruq pain. she reports increasing her intake of oranges over the last few weeks for her constipation. she denies any medication changes, dietary changes or change in warfarin dosing. she reports the sensation of increased bloating and abdominal girth over the last few weeks in addition to mild ruq pain that worsened over the course of the day prior to admission. she also reported a headache the day prior to admission. her history is notable for being on warfarin for pe in . she had a lgib and was admitted to a few years prior to her pe. she also a ugib and was admitted to over the summer. at endoscopy she was found to have a bleeding ulcer. she was discharged in ppis. . in the ed initial vital signs were: t 98.3 p 116 bp 126/54 r 18 o2 sat 100% on ra. patient was given ns 1l ivx1, pantoprazole 40 mg iv x1, tylenol 650 mg po x1, vitamin k 10 mg iv x1, and transfused 2u ffp and 2u prbc. she was hemodynamically stable throughout her ed admission. she was transfered to the micu for further management. imaging studied obtained this admission so far include a ct head which showed no signs of hemorrhage and abdominal us which showed no acites, a fatty liver, and no subcapsular hemorrhage. she was transfused an additional 2u prbc and her h/h rose to 10.2/28.2. a repeat h/h was essentially unchanged. her inr peaked at 18.0 and subsequently fell to 1.7 at the time of transfer. she is being tranfered to the for further management. past medical history: #) ? hemachromatosis, diagnosed by labs studies in ; however, subsequent genetic testing has been negative. she did undergo a port-a-cath placement due to poor peripheral venous access for serial phlebotomies which have been occurring since late and . #) cirrhosis seen on liver biopsy at , c/b ascites and sbp. egd in at osh showing portal hypertensive gastropathy, no varices #) history of ugi from gastric ulcers in at while on warfarin #) history of lgib in ? treated at #) seizure disorder, was on dilantin for over 20 years prior to being titrated down and switched over to keppra out of concern for hepatotoxicity #) iga deficiency, never had ivig or other therapy #) depression #) hyperlipidemia #) arthritis #) pulmonary embolism in , currently on coumadin social history: the patient is married and has one son and three grandchildren. she was previously a nurse but is currently on disability. the patient entered an alcohol detox program and has now been sober for 2.5months. she never smoked cigarettes. family history: there is a family history of heart disease and stroke in her mother's family. there is lung cancer and alcoholism present in her father's family. sister has celiac disease. physical exam: gen: nad, alert and oriented vs: 98.0 102/64 74 20 97%ra heent: mmm, supple, no lad or thyromegaly, jvd to the angle of the jaw cv: rr, tachycardic, nl s1s2 no s3s4 mrg, pulses 2+ at the carotid, radial, and dp pulm: ctab, no kyphosis or scoliosis abd: bs++, soft, nd, tender epigastrium, liver not palpable, spleen tip palpable, no masses limbs: trace le edema, no tremor or asterixis neuro: perrla, eomi, no nystagmus, reflexes 1+ bilat at the biceps and patella, toes down bilat pertinent results: 09:15am blood wbc-7.9# rbc-3.03* hgb-8.5* hct-25.7* mcv-85 mch-28.1 mchc-33.0 rdw-14.4 plt ct-233# 09:15am blood pt-101.2* inr(pt)-13.5* 09:15am blood urean-15 creat-0.7 na-142 k-4.0 cl-104 hco3-27 angap-15 04:23am blood wbc-5.2 rbc-3.76* hgb-11.1* hct-31.5* mcv-84 mch-29.4 mchc-35.2* rdw-14.7 plt ct-127* 07:45am blood pt-17.3* ptt-30.1 inr(pt)-1.6* 04:23am blood glucose-105 urean-9 creat-0.6 na-142 k-3.8 cl-107 hco3-29 angap-10 04:23am blood mg-2.6 . ct head w/o contrast study date of 9:08 pm there is no fracture, hemorrhage, edema, mass effect, shift of midline structures or evidence of major vascular territorial infarction. the ventricles and sulci are normal in size and configuration for the patient's age. the visualized paranasal sinuses and soft tissues are unremarkable. impression: no evidence of acute intracranial process. . abdomen u.s. (complete study) port study date of 9:21 pm -scale and color doppler son images were obtained that demonstrate the liver to be of increased echogenicity and heterogeneous echotexture compatible with known cirrhosis. there is no ascites. there is no subcapsular hematoma. there is no intra- or extra- hepatic bile duct dilatation and the common bile duct measures 4.3 mm. main portal venous flow is hepatopetal. limited views of the pancreas are normal. the gallbladder is not distended and there is no pericholecystic fluid, gallbladder wall thickening, or cholelithiasis. the right kidney measures 9.7 cm pole to pole and the left 12.4 with no evidence for hydronephrosis, nephrolithiasis, or renal mass. the spleen is of normal echotexture and measures 14.9 cm. impression: 1. no son evidence for subcapsular hematoma. 2. increased liver echogenicity consistent with patient's known diagnosis of cirrhosis, other forms of liver disease not excluded. evaluation for mass lesion severely compromised. 3. no ascites. 4. persistent splenomegaly. . brief hospital course: 57f with a hx of pe on warfarin + etoh cirrhosis and possible hemochromotosis admitted with symptomatic anemia with an h/h of 6.5/18.6 and inr of 18. her inr was reversed with ffp and vitamin k and she was transfused 4u prbc. her h/h stabilized and she underwent an elective endoscopy which showed mild gastritis. she was discharged off coumadin with close follow up to determine if the morbidity of anticoagulation outweighs the risks given this is her second gi bleed since her pe and there is little evidence that a single pe merits ac for >6 months. . # gib: likely in the setting of elevated inr with known portal hypertensive gastropathy. no history of varices, though patient does have known cirrhosis complicated by acites and recent weight gain with increased abdominal girth. baseline hct appears to be around 26-28 based on review of omr. of note, patient has chronic anemia, and iron studies in of this year demonstrated iron deficiency anemia with a ferritin of 17. her history is also notable for increasing constipation possibly due to melena as well as malaise, doe, and ha likely due to symptomatic anemia. discharged on ppi. discontinued warfarin as no longer needed for single pe and clearly morbid in the patient. egd showed mild gastritis and no bleeding varices or ulcers. . # coagulopathy: on review of omr, it appears that the patient has had a number of elevated ptts since starting ciprofloxacin for sbp ppx in addition to warfarin. during her last admission in , warfarin was repeatedly held for elevated inrs. patient denies any changes in her coumadin dosing or any other changes in medication. no clear precipitant at this time for profoundly elevated inr. now s/p 2u ffp and 10mg vitamin k iv. discontinued warfarin. pt is >1 year out from pe and there is little evidence of benefit of ongoing anticoagulation in a patient with a single event and no known hypercoaguable state. received additional dose of vitamin k for rising inr prior to discharge. . # cirrhosis: thought to be secondary to etoh, though patient does have a questionable history of hemachromatosis and had undergone serial phlebotomy in the past with minimal improvement. lfts were within normal limits on admission. of note, hbcab was positive in , no mention of hb viral load in omr. she is currently complaining of ruq discomfort and is tender on exam. additionally, she notes she has had increased abdominal distention over the last several week with no appreciable ascites on exam. she also has a history of sbo. continued ciprofloxacin hcl 250 mg po q24h for sbp ppx in the context of iga deficiency. continued furosemide 20 mg po daily and spironolactone 50 mg po daily once volume status improved. . # history of pe: diagnosed in . had been on warfarin for the last year now with her second gi bleed. discontinued warfarfin as above. . # seizure disorder: continued home levetiracetam 1000 mg po bid. . # depression: continued home venlafaxine xr 225 mg po daily. medications on admission: ciprofloxacin 250 mg daily furosemide 20 mg daily levetiracetam 1000 mg omeprazole 40 mg spironolactone 50 mg daily venlafaxine 225 mg sr daily vitamin d units daily gabapentin 100 mg po tid trazodone 50 mg qhs prn coumadin 6 mg daily potassium chloride sr 20 meq daily vitamin b12 100 mcg daily vitamin e 400 units po daily lactulose prn constipation tylenol, up to 4 tabs daily prn benadryl prn itching clobetasol 25% prn rash i caps areds formula ferrous sulfate 325 mg tid discharge medications: 1. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). 2. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 3. venlafaxine 75 mg capsule, sust. release 24 hr sig: three (3) capsule, sust. release 24 hr po daily (daily). 4. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 5. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 6. spironolactone 50 mg tablet sig: one (1) tablet po once a day. 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 8. gabapentin 100 mg capsule sig: one (1) capsule po q8h (every 8 hours). 9. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 10. cyanocobalamin 100 mcg tablet sig: one (1) tablet po daily (daily). 11. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po three times a day. 12. lactulose 10 gram packet sig: packets po three times a day as needed for constipation. 13. potassium chloride 20 meq packet sig: one (1) packet po once a day. 14. vitamin e 400 unit capsule sig: one (1) capsule po once a day. discharge disposition: home discharge diagnosis: primary: upper gi bleed . secondary: iga deficiency, hyperlipidemia discharge condition: stable hematocrit, tolerating pos, at baseline. discharge instructions: you were admitted with a very high inr and low hematocrit (measure of anemia). we believe that you bleed in your intestines or stomach because of your high inr. because this is your second bleeding event on warfarin (coumadin) we are stopping this medication. you should see your doctor within a week to determine if you should stay off it from now on. . please take your medications as ordered. we have made the following changes: 1. stop warfarin (coumadin) 2. start nadolol 20mg daily . please attend your follow up appointments. . please call your doctor or come to the emergency room if you experience bleeding, dizziness, shortness of breath, chest pain, palpitations, passing out, ongoing diarrhea or vomiting, or other concerning symptoms. followup instructions: provider: , md phone: date/time: 7:30 . please see your pcp within week of discharge procedure: esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: acute posthemorrhagic anemia alcoholic cirrhosis of liver portal hypertension epilepsy, unspecified, without mention of intractable epilepsy personal history of venous thrombosis and embolism anticoagulants causing adverse effects in therapeutic use hemorrhage of gastrointestinal tract, unspecified selective iga immunodeficiency 

Answer: The patient is high likely exposed to