Note that the film shows nucleated red blood cells, as may occur in any hemolytic anemia. It also shows Howell-Jolly Bodies, indicating hyposplenism. Hemoglobin electrophoresis will confirm the diagnosis. The spleen is palpable. The serum ferritin is normal, but in the context of active inflammation, this does not exclude iron deficiency.
Microcytosis can itself result from active inflammation even in the presence of normal iron stores.
The setting is so characteristic, that I think one is entitled to make this assumption. Iron deficiency 2. This man drinks a lot of ethanol, and has a macrocytic anemia and thrombocytopenia, both of which can occur with ethanol ingestion. The normal vitamin B 12 and red cell folate serve to exclude deficiency of either. In this circumstance, the likelihood of the ethanol being the cause is so high that further investigation, including a bone marrow, is not needed.