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Diagnostic Tests: Rouleaux Formations
Overview — What These Are
The structures shown are rouleaux formations, in which red blood cells stack together like coins. This stacking occurs when plasma proteins reduce the normal negative charge (zeta potential) between RBCs, allowing them to adhere to one another. Rouleaux formation is a nonspecific finding but often reflects elevated levels of certain plasma proteins.
Diseases Associated With Rouleaux Formation
Rouleaux commonly develops in conditions with increased abnormal globulins or elevated fibrinogen, including:
1. Multiple Myeloma
Other possible but less specific associations
But on board-style exams, multiple myeloma and macroglobulinemia are the classic associations.
Overview — What These Are
The structures shown are rouleaux formations, in which red blood cells stack together like coins. This stacking occurs when plasma proteins reduce the normal negative charge (zeta potential) between RBCs, allowing them to adhere to one another. Rouleaux formation is a nonspecific finding but often reflects elevated levels of certain plasma proteins.
Diseases Associated With Rouleaux Formation
Rouleaux commonly develops in conditions with increased abnormal globulins or elevated fibrinogen, including:
1. Multiple Myeloma
- Overproduction of monoclonal immunoglobulins (especially IgG) promotes RBC stacking.
- Supporting clues include:
- Anemia
- Hypercalcemia
- Renal failure
- Lytic bone lesions
- Abnormal SPEP (serum protein electrophoresis) or UPEP (urine protein electrophoresis) showing M-spik
- Characterized by high levels of IgM macroglobulin, which greatly increases blood viscosity.
- Also causes rouleaux due to elevated globulin levels.
Other possible but less specific associations
- Chronic inflammation
- Connective tissue disorders
- Certain infections
- Conditions with elevated fibrinogen (e.g., acute phase reactions)
But on board-style exams, multiple myeloma and macroglobulinemia are the classic associations.
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