A 65 yeаr оld wоmаn with RA whо is on DMARD therаpy and continues to have significant symptoms presents with the following hemogram: Hb= 10.1 g/dL (12-14 g/dL) Hct= 32% (36-42%) RBC=3.2 million/mm (4.2-5.4) MCV=82 fL (80-96fL) MCH= 28 pg (27-31 pg) RDW=12.8% (11-15%) Retic =0.7% (1-2%) These findings are most consistent with: