2.9: Rouleaux

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An interactive or media element has been excluded from this version of the text. You can view it online here:
https://pressbooks.library.ualberta.ca/mlsci/?p=260

Images of peripheral blood smears with rouleaux present. From MLS Collection, University of Alberta.

Image 1: 50x oil immersion. https://doi.org/10.7939/R3445HT5R

Image 2: 10x magnification. https://doi.org/10.7939/R3HQ3SD56

Image 3: 50x oil immersion. https://doi.org/10.7939/R3HM5313R

Cell Description:

Red blood cells are arranged into rows or linear chains, appearing on top of one another in a “coin stacking” fashion. The outlines of the the individual cells are usually seen.^1,2

Cell Formation:

Can form naturally after blood is collected and allowed to sit for a long period of time.¹

Similar morphology can be seen in the thick areas of a blood smear.¹ Pathological rouleaux is only reported when seen in the thin areas of a peripheral blood smear where a differential would usually be performed.³

In pathological states, the increase of plasma proteins (e.g. fibrinogen, globulins) will coat the red blood cells and cause them to become “sticky” and result in rouleaux formation.^1,4

Associated Disease/Clinical States:^2,5

*Associated with any condition that results in the increase of plasma proteins

Acute and chronic inflammatory disorders

Plasma Cell Myeloma (Multiple Myeloma)

Polyclonal or monoclonal hyperglobulinemia

Note: Unlike with agglutination, the formation of rouleaux can be reversed with the addition of saline.²

References:

1. Landis-Piwowar K, Landis J, Keila P. The complete blood count and peripheral blood smear evaluation. In: Clinical laboratory hematology. 3rd ed. New Jersey: Pearson; 2015. p. 154-77.

2. Rodak BF, Carr JH. Variations in shape and distribution of erythrocytes. In: Clinical hematology atlas. 5th ed. St. Louis, Missouri: Elsevier Inc.; 2017. p. 93-106.

3. Turgeon ML. Erythrocyte morphology and inclusions. In: Clinical hematology: theory and procedures. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999. p. 99-111.

4. Jones KW. Evaluation of cell morphology and introduction to platelet and white blood cell morphology. In: Clinical hematology and fundamentals of hemostasis. 5th ed. Philadelphia: F.A. Davis Company; 2009. p. 93-116.

5. Ford J. Red blood cell morphology. Int J Lab Hematol [Internet]. 2013 Mar 9 [cited 2018 Jul 12];35(3):351–7. Available from: https://doi.org/10.1111/ijlh.12082