Blood Quiz

A 66 y/o female with a hx of myelodysplasia, refractory anemia subtype, presents with a Hemoglobin of 9.3 g/dl with a newly reduced MCV of 59 fL . Her iron studies are significant for a ferritin of 425ng/ml, with an iron level of 245 ug/dl . a bone marrow aspirate shows increased erythroid precursors , Hemoglobin H inclusions are seen on her peripheral smear after staining with brilliant cresyl blue . Pt has no family hx of anemia & has previous hemograms that have been unremarkable. her peripheral smear stained with wright giemsa is shown above.
What is her most likely diagnosis?