A 34-year-old woman is evaluated because of progressive fatigue and recurrent attacks of abdominal pain. She weighs 61.2 kg (135 Ib). Her pulse rate is 110/min and her blood pressure is 110/70 mm Hg. She is pale, and her spleen is palpable 4 cm below the costal margin. Laboratory studies: Hemoglobin 6 g/dL
Hematocrit 20% Leukocyte count 2500/μL Platelet count 80,000/μL Reticulocyte count 10%
Blood smear Anisocytosis and polychromatophilia Haptoglobin 0 mg/dL
Serum lactate dehydrogenase 645 U/L
There is high level of hemosiderin in the urine.
What is the most likely cause of this patients pancytopenia?

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