What is the most likely etiology of his anemia?

C. Peripheral blood smear reveals small inclusions in the red blood cells that stain positive with Prussian blue for iron. These inclusions are called Pappenheimer bodies and represent lysomome containing iron-protein complexes. Such red cells are siderocytes. Siderocytes are considered to be the peripheral blood counterparts of bone marrow sideroblasts and are seen in cases of acquired SA secondary to heavy alcohol use. These cases are characterized by increased iron stores. Abstinence from alcohol is associated with disappearance of siderocytes and improvement in anemia. SCA is asso ciated with severe liver disease; however, this case does not exhibit increased acanthocytes, and there is no evidence of clinically significant hemolysis, no reticulocytosis, or indirect hyperbilirubinemia as would be expected in cases of SCA or AIHA. Normal platelet count and leukocytosis are not consistent with the diagnosis of AA. Other conditions that are contributory to the development of anemia in heavy alcohol users include the presence of hypersplenism, chronic gastrointestinal bleeding, direct cytotoxic effect of alcohol on the bone marrow, nutritional deficiencies, and anemia of chronic disease (Medicine Baltimore. 1986;65(5):322, Hematol Oneal Clin North Am. 1987;1(2):321).