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: brbpr, bleeding fistula major surgical or invasive procedure: colonoscopy hemodialysis history of present illness: 76 y f with h/o esrd on hd who generally gets her care at admitted to last night for av fistula bleed and possible lower gi bleed being transferrred to the micu for low blood pressures. . she initially presented to for concern for left av fistula bleeding, which was recently redone and starting to be used last week. since then, it has been bleeding after hemodialysis which she first noticed at home, so came in for evaluation. . in the ed, her sbp's ranged from 78-82 persistently. her initial hct was 34, and she was admitted for concern for gi bleeding. her coumadin was held. she was admitted to the medical floor, but triggered in the morning of for sbp 80 - she was mentating fine and on further review was felt to be close to her baseline. icu admission was requested for closer monitoring in the setting of possible gi bleeding. . ros: in addition to above, pt had lightheadedness earlier but currently does not feel dizzy either sitting or standing. she is hungry. she has no chest pain, shortness of breath, fever, chills. she had some nausea on monday with mucoid vomiting but no blood. she complains of some weakness of both legs, which is equal and at her baseline. past medical history: cardiac amyloid renal amyloidosis esrd on hd htn hyperlipidemia chf ? cad h/o cva - unclear pud s/p l thr paroxysmal atrial fibrillation baseline low blood pressures thrombocytopenia - in 80's in social history: pt lives alone but with family close. gets hd at center. no etoh and quit tob 20 yrs ago. no significant employee exposures family history: noncontributory physical exam: vs: tc 97.9 bp 80/62 p90 (nurse) p20 99% ra lying down - 76/55 p96 standing x 2 mins - bp 95/65 p96 pe: gen- comfortable, conversational, no distress heent- sclera muddy but anicteric, op wnl, mmm neck- supple, romi chest- bilateral inspiratory wheezes, no crackles card- rrr no mgr abd- soft, slight ttp lower quadrants, no masses or hsm, nabs ext- trace edema, wwp, left arm biceps fistula small, with thrill, bandage clean/dry/intact skin- normal turgor of thigh. no rash neuro- ao3, appropriate, answers questions and follows commands without problem, cns roughly intact, strength 5/5 thru/o pertinent results: 6:30p slightly hemolyzed 142 95 13 agap=16 -------------< 71 4.2 35 3.4 comments: k: hemolysis falsely elevates k estgfr: 13/16 (click for details) alt: 18 ap: 189 tbili: 1.3 alb: 4.0 ast: 51 ldh: 338 dbili: tprot: : lip: comments: alt: hemolysis falsely increases this result ast: hemolysis falsely elevates ast ld(ldh): hemolysis elevates ldh 98 5.0 \ 11.0 / 81 / 34.3 \ n:57.7 l:30.5 m:7.6 e:4.1 bas:0 comments: plt-ct: verified by smear hypochr: 2+ anisocy: 2+ macrocy: 3+ pt: 21.3 ptt: 100.9 inr: 2.1 comments: ptt: verified ptt: notified @ 7:27 pm on 04:45am blood wbc-4.9 rbc-3.38* hgb-10.4* hct-32.9* mcv-97 mch-30.9 mchc-31.8 rdw-20.6* plt ct-112* 04:45am blood wbc-4.9 rbc-3.38* hgb-10.4* hct-32.9* mcv-97 mch-30.9 mchc-31.8 rdw-20.6* plt ct-112* 10:30am blood hct-30.7* 07:00am blood wbc-4.7 rbc-3.20* hgb-9.9* hct-31.7* mcv-99* mch-31.1 mchc-31.4 rdw-21.0* plt ct-81* 06:30pm blood wbc-5.0# rbc-3.50* hgb-11.0* hct-34.3* mcv-98# mch-31.3# mchc-32.0 rdw-20.6* plt ct-81*# cxr impression: severe enlargement of the cardiac silhouette, likely cardiomegaly; however, pericardial effusion cannot be excluded. no acute pulmonary process colonoscopy: findings: mucosa: localized ulceration with stigmata of recent bleeding was noted in the rectum. these findings are compatible with solitary rectal ulcer syndrome. excavated lesions a few diverticula with small openings were seen in the sigmoid colon.diverticulosis appeared to be of mild severity. impression: ulceration in the rectum compatible with solitary rectal ulcer syndrome diverticulosis of the sigmoid colon otherwise normal colonoscopy to terminal ileum brief hospital course: # hypotension, concern for gi bleed - blood pressure appeared to be at her baseline per ed records and according to her is similar to her baseline. her blood pressure remained stable at all times. she was transferred to the icu where hct's were obtained q 6h. she was not transfused. access was maintained via 2 iv's and the dialysis catheter. she received ppi iv bid. gi was consulted and performed a colonoscopy. the patient's initial inr was 1.9 so she was given 5 mg po vitamin k for reversal prior to colonoscopy and prep with magnesium citrate. the colonoscopy showed a small rectal ulcer. the patient will need to follow up with a flexible sigmoidoscopy in weeks as an outpatient. she should continue colace 200-400 mg until then. she can restart coumadin and aspirin now. . # esrd: the patient received hemodialysis on with no complications via the catheter. renal was consulted and recommended a fistulogram, which could not be performed during hospitalization, so she should have this arranged as an outpatient and receive dialysis through the catheter until then. # wheezing, bicarb of 37: the patient could potentially have underlying lung disease. she received combivent with good response and was discharged with an albuterol inhaler. this could be from pulmonary amylod or asthma, and should be followed as an outpatient. # elevated alk phos/lft's - her alk phos and ast were noted to be elevated on admission, with slightly elevated ggt. she should get # thrombocytopenia: her recent baseline is 80 which were constant in the hospital. # history of paf. an ekg showed no changes and the patient remained at sinus. an episode of a fib was noted during hospitalization without increased rate. # h/o amyloidosis with chf: her fluid status was carefully monitored. she will start her outpatient medications when she returns home. medications on admission: meds: coumadin lipitor prilosec asa colace nephrocaps discharge medications: 1. colace 100 mg capsule sig: one (1) capsule po twice a day for 3 weeks. disp:*60 capsule(s)* refills:*3* 2. lipitor oral 3. prilosec oral 4. nephrocaps oral 5. warfarin 1 mg tablet sig: three (3) tablet po hs (at bedtime). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*12* discharge disposition: home with service facility: americare at home inc discharge diagnosis: rectal ulcer causing lower gi bleed av fistula bleeding wheezing, possibly from pulmonary amyloid esrd on hemodialysis cardiomyopathy amyloidosis asymptomatic hypotension at baseline, sbp 80-90 paroxysmal atrial fibrillation discharge condition: pt was feeling well, with systolic blood pressure of 85-90 and no other specific complaints. discharge instructions: you may return home. please continue all your previous medications, with the addition of colace 100 mg po bid for weeks or until your gastroenterologist suggests otherwise. please have your inr checked on monday and have your doctor adjust the dose of your coumadin as necessary. you received some vitamin k in the hospital so it may take some time for your inr to become normal again. if you have more bleeding in your stool that concerns you, dizziness, feeling that you're going to pass out, or any other concerns, please return to the ed or call your pcp. followup instructions: please follow up with your pcp weeks: , s. . please resume hemodialysis as previously arranged, starting on monday. please have your outpatient nephrologist arrange for an av fistulogram. if you need this procedure done at , please call for an appointment. please follow up with dr. from gi in weeks for repeat flexible sigmoidoscopy to ensure healing of your rectal ulcer. call ( to schedule an appointment. md, procedure: hemodialysis colonoscopy anoscopy diagnoses: other primary cardiomyopathies thrombocytopenia, unspecified end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere congestive heart failure, unspecified acute posthemorrhagic anemia atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia hypotension, unspecified surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants other complications due to renal dialysis device, implant, and graft lung involvement in other diseases classified elsewhere hemorrhage of rectum and anus other amyloidosis ulcer of anus and rectum nutritional and metabolic cardiomyopathy 

Answer: The patient is high likely exposed to