患者，男，60岁。食欲减退半年。查体示:巩膜轻度黄染，脾肋下lcm。血常规示：WBC3.1×109/L，Hb80g/L，Ret2%。骨髓细胞学检查示:幼红细胞增生明显活跃，以中晚幼红细胞为主。该患者最可能的诊断是

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