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: zestril / omeprazole attending: chief complaint: abdominal subcutaneous hematoma major surgical or invasive procedure: blood transfusion multiple abd ct scans upper and lower extremity ultrasounds history of present illness: ms. is a 62 y/o f with h/o iddm, h/o multiple pe's, on chronic anticoag, recently bridged on lovenox (150 ) for colonoscopy. lovenox was initiated on for colonoscopy performed on . she presents to the ed with large >15x40cm sq abdominal hematoma at site of lovenox injections. patient also noted to have drop hct by 7 point (37.6 -> 30.8). patient had colonoscopy two days prior to admission for evaluation of rectal bleeding episodes which had occurred 4-5x over the past few weeks. following the colonoscopy, she restarted coumadin () with ongoing lovenox for bridge to goal inr. patient noted over several days expanding bruise, then hard swelling on llq at injection sites. she was told by vna to stop using that site, but reports continued expansion. pt held lovenox on evening of given continued expansion. . per patient, she was reported to have only hemorrhoids. she denies any subsequent episodes of brbpr, hematochezia. she denies shortness of breath or chest pain. . patient had ct abdomen in ed which showed hematoma but no rp bleed. patient being admitted for serial hct checks. past medical history: 1. post-op pulmonary emboli () status post ivc filter secondary to retroperitoneal bleed on coumadin; sadddle embolus (), on coumadin for life 2. thoracic osteomyelitis status post 6 week treatment with vancomycin. also concern for underlying tumor that is being worked up. 3. insulin dependent diabtes complicated by neuropathy and retinopathy. 4. congestive heart failure diagnosed per patient. echocardiagram shows lvef 70% 5. chronic lower extremity edema 6. obesity 7. right foot ulcers 8. fibromyalgia 9. osteoarthritis, left knee status post "injection" and prior knee surgery . multiple surgeries: appendectomy, cholecystectomy (ex lap), partial hysterectomy 11. obstructive sleep apnea on bipap at night 13. l4-5 herniated disc, status post steroid injections 14. depression social history: she quit smoking 23 years ago - she started at age 13 with 1 pack per day and then increased to 2-3 packs per day until she quit. she denies alcohol. she lives at home with a son who is 20 years old and two biological sons. she has cleaning lady. she previously walked independently. family history: her brother had a stroke at age 65. there is a family history of diabetes, hypertension, and multiple sclerosis. physical exam: (on admission) pe: t 99.1 hr 84 bp 170/86 rr 16 o2sat 97% ra gen: obese wf, appears comfortable reclining in bed cv: distant heart sounds, regular rhythm resp: cta b/l abd: very large 15x40 cm hematoma in llq, extending to left flank, tender to palpation; large area of periumbilical firmness; candidal infection in crease below pannus extrem: 2+ dp pulses in rle, 1+ dp pulses in lle; 2+ pitting edema, blue bruise on medial aspect of left ankle; s/p amputation of 3rd digit of right foot, well-healed pertinent results: ct abdomen : large subcutaneous hematoma involving mid to left lower anterior tissues. no intraperitoneal or retroperitoneal component. lab data: cbc: ---on admission: 05:15am wbc-8.8 rbc-3.66* hgb-10.6* hct-30.8* mcv-84 mch-29.0 mchc-34.5 rdw-17.0* 05:15am neuts-71.5* lymphs-22.2 monos-3.7 eos-2.3 basos-0.2 05:15am hypochrom-1+ anisocyt-1+ microcyt-1+ 05:15am plt count-197 06:00am blood wbc-9.7 rbc-3.48* hgb-10.4* hct-30.5* mcv-88 mch-29.8 mchc-34.0 rdw-15.7* plt ct-312 06:20am wbc 10.4 3.46* 10.3* hct 30.8* 89 29.8 33.5 16.0* plt 408 10:45pm hct 28.8* 06:20am wbc 10.1 3.61* 10.4* hct 32.3* 89 28.9 32.4 15.8* plt 361 06:00am wbc 9.7 3.48* 10.4* hct 30.5* 88 29.8 34.0 15.7* plt 312 05:58am wbc 7.4 3.21* hgb 9.7* hct 28.1* 88 30.1 34.4 16.9* plt 246 ---acute change: 06:40am hct-28.3* mcv-86 mch-28.5 mchc-33.3 rdw-16.6* 12:38pm hct-21.3* mcv-87 mch-28.0 mchc-32.3 rdw-16.9* 06:34pm hct-23.5* 03:44am hct-25.0* mcv-86 mch-30.6 mchc-35.7*# rdw-15.7* coags: 05:15am pt-13.4 ptt-30.3 inr(pt)-1.2* 06:40am blood ptt-99.3 plt ct-265 06:34pm pt 16.1 ptt 26.0 inr 1.5* 12:38pm ptt >150 06:34pm pt 16.1* ptt 26.0 inr 1.5* 04:13am pt 13.4* ptt 27.4 inr 1.2* 03:17am pt 12.7 ptt 26.3 inr 1.1 06:20am pt 13.1 ptt 23.6 inr 1.1 --- : inhibitors & anticoagulants 06:20am aca igg 5.8 aca igm 10.4 06:20am prot c 127* prot s 61 06:20am lupus anticoag neg 05:20am lmwh 0.21 03:44am haptoglobin 198 chemistries: 05:15am glucose-233* urea n-36* creat-1.2* sodium-140 potassium-3.9 chloride-101 total co2-27 anion gap-16 11:09am glu 76 bun 17 cr 0.7 na 138 k 4.7 cl 103 hco3 27 ag 13 09:00pm glu 116 bun 31 cr 1.2 na 135 k 5.6 cl 99 hco3 30 ag 12 06:55am glu 91 bun 18 cr 0.7 na 140 k 4.8 cl 104 hco3 28 ag 13 06:15am glu 124 bun 20 cr 0.8 na 140 k 4.6 cl 103 hco3 30 ag 12 11:25am glu 99 bun 25 cr 0.9 na 137 k 4.8 cl 101 hco3 30 ag 11 06:05am glu 82 bun 29 cr 1.0 na 136 k 5.1 cl 100 hco3 29 ag 12 05:58am glu 80 bun 25 cr 0.9 na 140 k 4.0 cl 101 hco3 30 ag 13 lfts: 05:15am alt(sgpt)-21 ast(sgot)-18 ld(ldh)-211 alk phos-104 amylase-24 tot bili-0.3 05:15am lipase-15 05:15am albumin-3.6 urine: 08:25am urine rbc-0 wbc-21-50* bacteria-mod yeast-few epi-0-2 08:25am urine blood-tr nitrite-neg protein-neg glucose-250 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 08:25am urine color-yellow appear-hazy sp -1.019 ct abd (): large subcutaneous hematoma involving mid to left lower anterior abdomen. no intraperitoneal or retroperitoneal component. ct abd (): 1. large subcutaneous hematoma, similar in size to perhaps slightly decreased, with similar fluid-fluid levels. 2. increased nonspecific stranding along the left flank which may relate to edema and/or redistribution of hemorrhagic products. cxr (): the lung volumes are relatively low, likely accentuating the cardiac silhouette and bronchovascular structures. this limits assessment of the cardiovascular status of the patient. no confluent areas of consolidation are evident in either lung. however, considering the concern for pneumonia, dedicated pa and lateral radiographs may be helpful to more fully evaluate the lungs if clinical suspicion for infection persists. ct abd (): 1. limited study secondary to beam hardening artifact. large left femoral sheath hematoma extending from the liver tip on the contralateral side, into the pelvis. fluid, fluid levels seen with within this large hematoma. estimated that 50% of hematoma is free flowing. 2. largely resolved subcutaneous hematoma when compared to the previous study. ct abd (): 1. stable large left hematoma and smaller subcutaneous hematomas. 2. ivc filter without evidence of ivc thrombus. lower ext us (): no dvt in either lower extremity. ct abd (): 1. stable appearance of large left lateral abdominal wall hematoma and smaller subcutaneous hematomas. no new sites of hematoma in this non-contrast scan. 2. small left pleural effusion. minimal bibasilar atelectasis. 3. ivc filter, unchanged. upper ext us (): findings: grayscale and doppler son of the right and left internal jugular, subclavian, axillary, basilic, and cephalic veins were performed. these demonstrate normal compressibility, waveforms, augmentation, and flow. no intraluminal thrombus is identified. impression: no evidence of upper extremity dvt. brief hospital course: this is a 62 year-old female with history of congestive heart failure, diabetes , multiple pulmonay emboli on chronic anticoag who was recently bridged on lovenox for colonoscopy and presented with an abdominal hematoma. . 1) hematoma: patient had been on chronic anticoagulation with warfarin and an ivc filter given history of pulmonary emboli. she developed a large subcutaneous abdominal hematoma likely secondary to high dosage lovenox sc injections. ct showed collection in subcutaneous tissue with increased stranding posteriorly (? dependant movement of hematoma). restarted warfarin on , however, subsequently developed hematocrit drop from 29 to 21 as a result of over-anticoagulation with heparin during warfarin bridging. she was found to be guaiac negative but abdominal ct showed a new, large rectus sheath hematoma. her anticoagulation was discontinued, she was transfused 2 units of blood and then transferred to micu for protamine reversal. . micu course included multiple transfusions of red blood cells as well as ffp. a central venous catheter was placed and removed just prior to her discharge to the floor. hct improved to 28.7 by . . pt was transferred out of micu on once her hct had stabilized. she remained stable with pain in the site of the hematoma and had pt and ot coming to see her. she was able to slowly begin ambulating more and further each day with aid. on pt seemed to have acutely worse pain and an abd ct was obtained which showed no change in the hematoma even though the hct went from 32.3 to 28.8 but returned to baseline the next morning to 30.8. other than increasing ambulation and getting the pt's pain under control with oxycodone sr 30mg q12h and oxycodone 20mg q4hr as well as 1-2mg iv morphine q3-4hr prn for breakthrough pain. pt was started on a lidoderm patch to try to help control pain at site of hematoma. pt was also maintained on her gabapentin which was increased to 300, 300, 400mg a day to help with her neuropathic pain from dm. . vascular and were following the pt while she was hospitalized. vascular assessed that the hematoma did not need to be drained surgically and that her ivc filter was still in good position and should not be replaced. (dr. ordered clotting studies on pt but none were determined to be abnormal. , vascular surgery, and ophthomalogy all assessed pt and her history and gave opinions about whether pt should restart anticoagulation at any point. . ophthomalogy remarked that her hemorrhages in her eyes were due to the anticoagulation as well as her dm and that she should still be anticoagulated even if it meant bleeding in her eyes if it kept her from having a fatal pe. . vascular surgery (dr. felt that her risks of bleeding outweighed her risks of having a pe and that her ivc would help prevent a pe while another bleed might be fatal. they remarked that if she was restarted on anticoagulation that it should be coumadin and not heparin or lovenox as she seemed to have more bleeding problems from those anticoagulants than coumadin and that no anticoagulation should be started until her hematoma has resolved. . had suggested restarting coumadin without a heparin bridge and starting and adjusting the dose very gingerly with tight inr monitoring and control as they did not think she had a bleed while on coumadin. they wanted to better assess the pt's bleeding and anticoagulation that she was on when she had the bleeding and it seemed that the pt bled when supratherapeutic on lovenox and heparin but not coumadin. however, neither or the pt's pcp wanted to start back any anticoagulation for at least 2weeks after discharge from the hospital. . the pt will be following up with in 2 weeks after discharge, with ophthomology 2.5 weeks after discharge and with dr. in 2weeks after discharge. . 2) cough/wheezing: possible secondary to reactive airway disease, due to patient's extensive smoking history. however, per patient, past spirometry studies showed only restrictive disease secondary to obesity and now obstructive or reversible process. her oxygen saturations remained stable during the hospitalization and her chest x-ray was unremarkable for infiltrative process. she was placed on standing nebulized treatments and this alleviated the symptoms to some extent. chest x-rays showed no pleural effusion or pneumothorax. on the medical floor, sao2, bp, and rr were stable; patient had no chest pain or pressure to indicate pulmonary embolus. she was maintained well on her nebulizers and bi-pap at night for her osa. . 3) visual changes. patient reported decrease in vision on presentation to ed, especially with straining, movement. one month pta, she had experienced hemorrhage into left eye per patient report. ophtho consultation diagnosed bilateral vitreous hemorrhage and noted that the patient was legally blind, though it was not confirmed that this was due to recent antigoagulation because the patient has significant diabetes. no intervention was planned, and outpatient follow-up at was recommended. it was unclear whether bleeding continued through the hospital course. patient does have services at home prior to hospitalization but may require additional services after discharge. she will have a follow up appointment in ophthalmology on discharge in 2.5 weeks with possible ultrasound to assess for retinal bleeding at that appointment. she was also given stool softeners and cough suppressants to decrease strain. her ophthalmologist is as follows. (monvi ) since she was diagnosed as legally blind she spoke with sw in regards to finding appropriate housing and services after she is done with rehab. . 3) diabetes : patient was maintained on her home regimen of 42 units glargine at night plus sliding scale insulin coverage. coverage was good, and sugars were in the low 100s on the medical floor. her sugars went up a bit when pt regained her appetite and became lax in regards to her diet, but by dishcarge were very well controlled on her home regimen, especially after came to see her and adjusted her evening scale slightly. a nutrition consult also was ordered to help remind/educate the pt on what foods to avoid. . 4) arf: elevated creatinine on admission 1.2 (baseline 0.8) likely of pre-renal etiology, secondary to volume loss from hematoma. following volume repletion, cr returned back to baseline. on the pt's creatitine starting to rise slowly and reached as high as 1.2 which was again likely caused by prerenal causes secondary to pt being off ivf and not taking in enough fluids to counteract her being on her diovan and lasix home doses. the diovan was stopped and the lasox was held for 3 days and restarted back at 40mg for two days before agains being on 80mg dialy home dose again. . 5) complicated urinary tract infection, with urine culture that initially grew klebsiella, pan-sensitive. completed 7-day course of ciprofloxacin on . culture later grew cipro-resistant but tmp/smx-sensitive e. coli. bactrim was begun x7 days. new ua and culture show e. coli uti, resistant to bactrim and foley was removed and pt was started on ceftriaxone for 10 days and follow up ua was negative for uti and the culture is pending. pt is asymptomatic. pt was restarted on her home dose of urecholine for urinary retention on . . 6) hypercholesterolemia: continued simvastatin . 7) depression: continued celexa . 8) osa: bipap at home settings of 11 i, 8 e. . 9) fen: diabetic diet. . 10) prophylaxis: pneumoboots. prior to icu admission, patient was maintained on an iv heparin drip with a plan to start coumadin when ptt reached 60-80. hct was noted to be as low as 27, and blood transfusions were given prn. coumadin was re-introduced . with fall in hct and icu admission, pharmacologic anticoagulation was dc'ed entirely. she will be kept on pneumoboots for rehab. pt was maintained on a bowel regimen to keep her bms regular and to decrease straining to help maintain . 11) full code. medications on admission: lovenox 150 mg sc bid coumadin diovan 80mg daily gabapentin 400mg lantus 42u qhs lasix 80mg daily mirapex 0.5mg qhs and 0.25mg afternoon omeprazole 20mg oxycodone prn simvastatin 10mg qhs spectravite 18mg daily ultram 100mg qid urecholine 25mg qid celexa 40mg qhs discharge medications: 1. pramipexole 0.25 mg tablet sig: two (2) tablet po qhs (). tablet(s) 2. pramipexole 0.25 mg tablet sig: one (1) tablet po afternoon; 1pm (). 3. simvastatin 10 mg tablet sig: one (1) tablet po hs (at bedtime). 4. citalopram 20 mg tablet sig: two (2) tablet po hs (at bedtime). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 9. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 10. fluticasone 50 mcg/actuation aerosol, spray sig: one (1) spray nasal (2 times a day). 11. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 12. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). 13. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 14. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). 15. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 16. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 17. zolpidem 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for insomnia. 18. oxycodone 5 mg tablet sig: four (4) tablet po q4h (every 4 hours) as needed. 19. oxycodone 10 mg tablet sustained release 12hr sig: three (3) tablet sustained release 12hr po q12h (every 12 hours). 20. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 21. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for pain. 22. gabapentin 100 mg capsule sig: one (1) capsule po hs (at bedtime). 23. insulin glargine 100 unit/ml solution sig: forty two (42) units subcutaneous at bedtime. 24. insulin lispro (human) 100 unit/ml solution sig: sliding scale units subcutaneous four times a day: please follow sliding scale. 25. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day) as needed for irritation. 26. bethanechol chloride 25 mg tablet sig: one (1) tablet po qid (4 times a day). 27. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 28. morphine sulfate 1-2 mg iv q3-4h:prn discharge disposition: extended care facility: & rehab center - discharge diagnosis: 1. abdominal hematoma 2. anemia 3. hypercoagulable state, unspecified 4. diabetes , insulin-dependent 5. obstructive sleep apnea 6. lower extremity edema 6. depression discharge condition: stable discharge instructions: you were admitted for an abdominal hematoma. while in the hospital you received blood transfusions and supportive care. . please schedule follow-up appointments with 1. dr at the within the next two and a half weeks, 2. dr at and 3. dr your pcp within the next two and a half weeks. . while in the extended care facility, you should wear pneumoboots to prevent developing a dvt. you should not receive any anticoagulation for the next two weeks. followup instructions: you have the following appointments already scheduled: 1. gates, msn phone: date/time: 10:15 2. ,gastric gastric bypass non billing date/time: 11:00 3. , m.d. phone: date/time: 1:30 please schedule the following appointments: 1. , md ophthalmology at for a retinal ultrasound within 2 1/2 weeks. phone: . 2. , . phone: or 3. , primary care within 2 1/2 weeks. phone:. procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation transfusion of packed cells transfusion of other serum diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes long-term (current) use of insulin long-term (current) use of anticoagulants personal history of venous thrombosis and embolism primary hypercoagulable state obesity, unspecified anticoagulants causing adverse effects in therapeutic use hypovolemia legal blindness, as defined in u.s.a. osteoarthrosis, unspecified whether generalized or localized, lower leg diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy candidiasis of skin and nails spontaneous ecchymoses vitreous hemorrhage contusion of abdominal wall 

Answer: The patient is high likely exposed to