Hyperpigmentation and Fatigue

Brownish-black pigmentation over her fingers and on the palms of her hands
Brownish-black pigmentation over her fingers and on the palms of her hands

A 40-year-old woman, who was on a strict vegetarian diet, presented to hospital complaining that she got tired easily.

Looking at the photograph of her hands, what is a peripheral blood smear most likely to show and what’s the diagnosis?