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=== More misshapen red blood cells === The shape of red blood cells has been found to be unusual in ME/CFS patients in several studies.{{Citation needed}} This can also slow blood flow, as well as change how molecules dock on the surface of a red blood cell. One study found significantly increased quantities of [[Stomatocyte|stomatocytes]] in the blood of CFS patients. Stomatocytes are red blood cells that have lost their concave shape, usually due to a [[membrane]] defect.<ref>{{Cite journal | last = Richards | first = RS | last2 = Wang | first2 = L | last3 = Jelinek | first3 = H | date = Jan 2007 | title = Erythrocyte oxidative damage in chronic fatigue syndrome | url =https://www.sciencedirect.com/science/article/pii/S0188440906002992 | journal = Archives of Medical Research | volume = 38 | issue = 1 | pages = 94-98|via=}}</ref> Both changes in deformability and changes in shape can be related to the way nutrients are or are not being processed in the body. For example, excess cholesterol can change the shape of red blood cells in some conditions by adhering to the outside of the membrane.<ref>{{Cite journal | last = Owen | first = J.S. | last2 = Brown | first2 = D.J. | last3 = Harry | first3 = D.S. | last4 = Beaven | first4 = G.H. | last5 = McIntyre | first5 = N .... | last6 = Gratzer | first6 = W.B. | date = Dec 1985 | title = Erythrocyte echinocytosis in liver disease. Role of abnormal plasma high density lipoproteins |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC424351/ | journal = J Clin Invest| publisher = | volume = 76 | issue = 6 | pages = 2275β2285|via=}}</ref> While deformability and unusual red blood cell shape can be indicative of ME/CFS, these abnormalities also occur in other conditions. For example, red blood cell deformability is affected in parasitic infections such as malaria, and metabolic disorders such as diabetes;<ref>{{Cite journal | last = Tomaiuolo | first = G. | date = 2014 | title = Biomechanical properties of red blood cells in health and disease towards microfluidics |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189537/ | journal = Biomicrofluidics | volume = 8 | issue = 5 | pages = |via=}}</ref> and unusual red blood cell shape is found in several nutritional deficiencies.<ref>{{Cite web | url = https://laboratoryinfo.com/wp-content/uploads/2015/04/Poikilocytosis-abnormal-rbc-shape.jpg | title = Poikilocytosis -- Abnormal RBC shape | date = 2017 | website = Laboratory Info}}</ref> While unusual shape and decreased deformability may be said to be signs of illness, they are not characteristic of ME/CFS alone.
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