Rouleaux formation

Stacking of red blood cells into formations resembling rolls of coins, caused by increased plasma proteins (especially fibrinogen and immunoglobulins) that promote erythrocyte aggregation and often associated with elevated erythrocyte sedimentation rate (ESR).

Causes

• Inflammatory and autoimmune causes

  • Connective tissue diseases

  • Trauma

  • Surgery

• Infections

• Plasma cell and hematologic disorders

  • Multiple myeloma

  • Waldenström's macroglobulinemia

  • Other monoclonal gammopathies

• Malignancy: Carcinoma, lymphoma

• Physiological causes: Pregnancy, aging

• Liver cirrhosis

• Hyperproteinemia of other causes

• Artifact: Poorly prepared blood smear