Rouleaux formation:
Rouleaux formation is a RBC phenomenon that is caused by an increased concentration of plasma proteins such as fibrinogen, globulin, or paraproteins in the blood. The characteristically flat surface of the discoid RBCs provides a large surface area to make contact and stick to each other; thus, forming a coin-stacking like formation known as rouleaux formation. In particular, fibrinogen, an acute phase protein promotes the interaction of sialic acid with the surface of RBCs resulting in the formation of this rouleaux phenomenon. When this phenomenon is observed throughout the PBF slide, then you have to measure the Erythrocyte Sedimentation Rate (ESR).This is because a rouleaux formation with a few RBCs sticking onto one another on tangent will increase their density leading to an accelerated sedimentation and it will increase ESR…
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