A 39-year-old man with chronic alcoholism is brought to the hospital after a fall, while intoxicated. He has completely recovered except for a bruise on his shoulder. His only abnormality is low hemoglobin of 9.6 g/dL, the platelets and WBC are normal. Additional tests including ferritin, vitamins B12, and folate are normal. Which of the following findings is most likely to be seen on his peripheral blood film?

Macrocytosis is frequently seen in patients with chronic alcoholism for multiple reasons including vitamin B12 or folate deficiency, chronic liver disease, and also from the direct toxic effects of alcohol on red cells. Because both iron deficiency and folate deficiency are very common in alcoholics, a dimorphic blood film can also be seen (macrocytes, hyper segmented neutrophils, and hypochromic microcytes can be found) on the same slide.