A 63-year-old woman comes to the physician for a 5-month history of fatigue. A blood smear is shown. Laboratory studies show:
Hemoglobin 11 g/dL
Platelets 200,000/μL
WBC 55,000/μL
Neutrophils 50%
Lymphocytes 25%
Metamyelocytes 5%
Promyelocytes 4%
Myelocytes 4%
Other 12%
Which of the following is most likely to be seen in this patient?