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Red cells are smaller than normal lymphocytes and significantly smaller than granulocytes.
If red cells are smaller than normal they are described as microcytic and if larger than normal as macrocytic. They are referred to as microcytes or macrocytes respectively.
Red cells of normal size are said to be normocytic. Ovalocyte can be graded as +, ++ or +++ (mild, moderate or severe).

Test results
When oval and/or elliptical cells are present it is not normal. Found in hereditary elliptocytosis, iron deficiency anemia, myelofibrosis.
Hereditary elliptocytosis, also known as ovalocytosis, is an inherited blood disease in which an abnormally large number of the sufferer's erythrocytes (i.e. red blood cells) are elliptical rather than the typical biconcave disc shape. It is one of many red-cell membrane defects. In its severe forms, this disease predisposes to haemolytic anaemia.
The vast majority of those with hereditary elliptocytosis require no treatment whatsoever. They have a mildly increased risk of developing gallstones, which is treated surgically with a cholecystectomy if pain becomes problematic.
Folate helps to reduce the extent of haemolysis in those with significant haemolysis due to hereditary elliptocytosis.
Because the spleen breaks down old and worn-out blood cells, those individuals with more severe forms of hereditary elliptocytosis can have a splenomegaly, which causes a worsening of the signs and symptoms of their anaemia. These can include:
·   Vague, poorly localised abdominal pain  
·   Fatigue and dyspnoea  
·   Growth failure  
·   Leg ulcers  
·   Gallstones.  
Removal of the spleen (splenectomy) is effective in reducing the severity of these complications, but is associated with an increased risk of overwhelming bacterial septicaemia, and is only performed on those with significant complications. Because many neonates with severe elliptocytosis progress to have only a mild disorder, and because this age group is particularly susceptible to pneumococcal infections, a splenectomy is only performed on those under 5 years old when it is absolutely necessary.
Because chronic haemolysis increases an individual's risk of gallstones, people with elliptocytosis have an increased risk of suffering from gallstones. This risk is relative to the severity of the disorder, and those with symptomatic elliptocytosis should have regular abdominal ultrasounds to monitor the progression of their gall bladder disorder.

Definitions of cells by shape
Cell which is approximately spherical in shape so that it has lost its central pallor; the cell outline is regular
Spherocyte of reduced size and therefore diameter
Irregularly contracted cell
Cell of reduced size and diameter with a lack of central pallor but with an irregular outline
Cell with an elliptical outline
Cell with an oval outline
Teardrop poikilocyte
Cell shaped like a tear, less often known as a dacrocyte
Target cell
Cell with a more strongly staining area in the centre of the area of central pallor
Cell with a central slit or stoma
Cell with two or four curved horn-shaped projections
Schistocyte (red cell fragment)
Fragment of a cell, usually angular; a microspherocyte is a particular type of schistocyte
Echinocyte (crenated cell)
Cell with its surface covered with 20–30 small, regular, blunt projections
Cell with its surface covered with two to twenty projections of irregular shape and irregularly distributed
Sickle cell
Cell with a sickle or crescent shape, caused by the presence of a high concentration of an abnormal haemoglobin known as haemoglobin S
Boat-shaped cell
Cell similar in shape to an elliptocyte but with both ends being pointed, usually indicative of the presence of haemoglobin S
SC poikilocyte
Bizarre poikilocyte formed when cells contain both haemoglobin S and haemoglobin C, having some curved edges and some square or rectangular protrusions

All information on this page is intended for your general knowledge only and does not provide medical advice, diagnosis or treatment.