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: history of present illness: ms. is a 68-year-old primarily russian-speaking female who has been diagnosed with myeloproliferative disorder several years ago. the patient has been closely followed by her primary care physician, she also has a hematologist/oncologist. the patient has undergone radiation treatment for her splenomegaly several years ago. the spleen has recently increased in size, and the patient has been somewhat symptomatic. the patient's comorbidities included coronary artery disease (with a myocardial infarction in ) as well as a history of hypertension. in addition, she had a left-sided nephrectomy and breast carcinoma with a left-sided mastectomy in . the patient presented to general surgery for a possible surgical solution of her splenomegaly due to her myeloproliferative disorder. the patient received all of her previous treatments at outside facilities. the patient was consequently scheduled for an elective open splenectomy by the general surgery staff. on , the patient underwent open splenectomy by dr. . the procedure was without any complications. the estimated blood loss was approximately 600 cc, and the patient received one unit of packed red blood cells. please see the full operative report for details. past medical history: 1. myeloproliferative disorder. 2. coronary artery disease. 3. status post myocardial infarction in . 4. hypertension. 5. breast carcinoma; status post left-sided mastectomy in . past surgical history: 1. left-sided mastectomy for breast carcinoma in . 2. status post left-sided nephrectomy. 3. status post eye surgery. medications on admission: 1. hydroxyurea 500 mg p.o. q.d. 2. ambien 10 mg p.o. q.h.s. as needed. 3. trazodone 50 mg p.o. as needed. 4. lopressor 50 mg p.o. b.i.d. 5. allopurinol 300 mg p.o. q.d. 6. norvasc 5 mg p.o. q.d. 7. prilosec. physical examination on presentation: physical examination revealed alert and oriented, in no apparent distress. an elderly, primarily russian-speaking, female. temperature was 98.4, blood pressure was 142/74, heart rate was 78, respiratory rate was 17, oxygen saturation was 97% on room air. head, eyes, ears, nose, and throat examination was within normal limits. no signs of lymphadenopathy. full range of motion in the neck. no carotid bruits were detected. cardiovascular examination revealed a regular rate and rhythm. no murmurs, rubs, or gallops. pulmonary examination revealed clear to auscultation bilaterally. the abdomen was soft, nontender, and nondistended. an enlarged spleen extending below the umbilicus was palpable in the left upper quadrant. bowel sounds were present. chest examination revealed the site of prior mastectomy. extremities were warm and well perfused. no signs of edema. hospital course: given the history of myeloproliferative disorder and significant splenomegaly, a surgical intervention was undertaken. on , the patient underwent open splenectomy. the procedure was without any complications with an estimated blood loss of approximately 600 cc. please see the full operative report for details. the patient was extubated successfully and transferred to the postanesthesia care unit in stable condition. she was originally made nothing by mouth and was adequately resuscitated with intravenous fluids. she was transfused with one unit of packed red blood cells in the operating room. she was placed on a beta blocker and subcutaneous heparin. her pain was adequately controlled. she was placed on prophylactic antibiotics. the patient maintained a low-grade fever and remained somewhat tachycardic. she was further resuscitated with fluids given her low urine output. a nasogastric tube was placed. her postoperative hematocrit was 34.2 with a white blood cell count of 11. given the symptoms of nausea, a kub of the abdomen was obtained which showed diffuse dilatation of the small bowel and colon; consistent with postoperative ileus. on postoperative day three, the patient was noted to be hypotensive, and she was noted to have her hematocrit decrease from 36 to 21.2. at that point, she was taking aspirin. the patient was quickly taken to the operating room on for exploratory laparotomy and evaluation of the bleed. intraoperatively, the patient was found to be coagulopathic, but no discrete source of the bleed was found. the patient was transfused with several units of packed red blood cells as well as platelets. several liters of blood were aspirated from the abdomen. before the exploratory laparotomy, she was found to have an inr of 4.3. she had been on lovenox and coumadin. after the exploration, the patient was transferred to the intensive care unit. a central line was placed. the patient remained intubated. her hematocrit was increased with several transfusions. her urine output remained adequate. she was maintained on intravenous fluids. several blood cultures were taken which showed no growth. the patient was extubated on postoperative day five and two. total parenteral nutrition was started given that the patient had been without any oral intake for several days. she continued to have a low-grade fever. the patient was consequently transferred to the regular floor on postoperative day six and three. the nutrition service was consulted, who followed the patient throughout her hospitalization. an electrocardiogram performed at the time showed a sinus rhythm, and no change compared to the baseline tracing available. the patient continued to be coagulopathic even without receiving any coumadin or other anticoagulation products. her wound remained clean, dry, and intact. there was some abdominal distention noted. she was started on clear liquids, and her diet was very slowly advanced; which she tolerated well. given the persistent elevated temperatures and distended abdomen, a computed tomography of the abdomen was performed on . there was no evidence of abscess. however, diffuse ascites were noted. in addition, bilateral pleural effusions were noted; which were associated with atelectasis at both lung bases. a successful ultrasound-guided paracentesis of the ascites was performed on . the patient would have several such paracentesis procedures. cultures were obtained from the fluid which showed no microorganisms; only polymorphonuclear leukocytes. in addition, the white blood cell count in the fluid was low and not suggestive of any infection. the patient was consequently placed on unasyn for empiric coverage. the patient also had several urine cultures obtained which grew escherichia coli as well as corynebacterium species. in addition, her sputum grew yeast. as perviously mentioned, her blood cultures grew nothing. the patient continued to be diuresed. her hematocrit remained stable; although, she continued to be anemic, and at some point required more blood. the patient was consequently restarted on coumadin. in addition, the renal service was consulted given the ascites; with the specific question of whether ascites were from a renal etiology and also the significance of proteinuria which was noted on routine urinalysis. in addition, the cat scan that was obtained on showed evidence of portal vein thrombosis which was confirmed by the ultrasound. it was thought that the significant ascites that seemed to reaccumulate after therapeutic paracenteses were due to the portal vein thrombosis and not renal failure. the patient's creatinine did increase slightly but then returned back to the patient's baseline of approximately 1.5. on , the patient appeared to have a relatively sudden onset of chest discomfort as well as tachypnea. there was no nausea, vomiting, or diaphoresis. she appeared to be tachypneic with a respiratory rate of approximately 35, but her blood pressure and heart rate were stable, and her oxygen levels remained the same. a arterial blood gas was obtained at that time which showed a ph of 7.53, po2 of 75, and pco2 of 19, with a base excess of -3, and total co2 of 16. she ruled out for a myocardial infarction by cardiac enzymes, and her lung scan was low probability of any pulmonary embolism. a venous ultrasound of the lower extremities was also negative for any clots. given these symptoms, the patient was again admitted to the intensive care unit for closer monitoring. she was continued on unasyn and intravenous heparin. she continued to make adequate urine. she remained on beta blocker. her electrocardiogram showed no changes. however, the chest x-ray did show left lower lobe consolidation. the patient remained stable and was transferred out of the intensive care unit to the regular floor. she continued to be coagulopathic with an inr of 2.6 on . she was also noted to have a white blood cell count of 48 and a platelet count of approximately 2 million. her liver function tests were elevated; consistent with portal vein thrombosis seen on the cat scan and ultrasound. the hematology/oncology service was consulted given the elevated white blood cell count and platelets. the patient was restarted on hydroxyurea. her white blood cell count and platelet count decreased slowly with this medication. in addition, the patient underwent one round of plasmapheresis which she tolerated well. while on hydroxyurea, the patient's white blood cell count decreased significantly and was noted to be 0.4 several days later. consequently, hydroxyurea was stopped. the patient was placed on neutropenic precautions. hydroxyurea was discontinued. the patient was place g-csf (growth factor) to which she responded well, and g-csf was discontinued several days later. the renal service continued to follow the patient, and they thought that her proteinuria was secondary to a nephrotic syndrome. they recommended further diuresis and oral fluid restriction. the patient continued to improve, and her ascites decreased significantly toward the end of her hospitalization. she was making significant urine. her liver function tests improved and were essentially normal. she was continued on coumadin with a stable regimen of 2.5 mg toward the end of her hospitalization. she continued to tolerate an oral diet without any difficulties. the staples were removed on postoperative day 18. while the patient was on neutropenic precautions; secondary to a low white blood cell count, she was maintained on cefepime intravenously which was discontinued when the neutropenic precautions were removed. her lower extremity edema decreased significantly as well. discharge disposition: the patient continued to improve significantly and was discharged to home on . pertinent laboratory values on discharge: her laboratories upon discharge were as follows: white blood cell count was 7.9 and hematocrit was 27.8 (differential with 70% neutrophils), platelet count was 389. inr was 2.2. condition at discharge: condition on discharge was good. discharge status: discharge status was to home. discharge diagnoses: 1. myeloproliferative disorder. 2. status post open splenectomy; complicated by intra-abdominal bleed, status post re-exploration and aspiration of intra-abdominal bleed. 3. portal vein thrombosis. 4. anemia. 5. coagulopathy. 6. hypertension. 7. coronary artery disease. medications on discharge: 1. coumadin 2.5 mg p.o. q.d. 2. potassium chloride 20 meq p.o. b.i.d. (while the patient is taking lasix). 3. lasix 80 mg p.o. b.i.d. 4. lisinopril 5 mg p.o. q.d. 5. ambien 5 mg p.o. q.h.s. as needed (for insomnia). 6. colace 100 mg p.o. b.i.d. 7. allopurinol 200 mg p.o. q.d. 8. protonix 40 mg p.o. q.d. 9. lopressor 75 mg p.o. b.i.d. 10. artificial tears one to two drops as needed. discharge instructions/followup: 1. the patient was to take 2.5 mg of coumadin q.d., and she was to see her primary care physician (dr. in approximately two to three days for an inr check and any adjustment of coumadin. the inr goal is approximately 2.5; but one needs to be careful given the history of coagulopathy with this patient. 2. the patient was to follow up with her hematologist/oncologist (dr. ) in approximately one week. 3. the patient was to follow up with her surgeon (dr. ) in approximately two to three weeks. , m.d. dictated by: medquist36 d: 15:32 t: 16:11 job#: procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances percutaneous abdominal drainage arterial catheterization reopening of recent laparotomy site total splenectomy therapeutic plasmapheresis diagnoses: hyposmolality and/or hyponatremia hemorrhage complicating a procedure urinary complications, not elsewhere classified other and unspecified coagulation defects portal vein thrombosis nephrotic syndrome with unspecified pathological lesion in kidney 

Answer: The patient is high likely exposed to