Rouleaux and Agglutination

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The page below is a sample from the LabCE course Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Rouleaux and Agglutination

Cell TypeImageCellular DescriptionAssociated Diseases and Conditions
  • Red blood cells (RBCs) appear as "stacked coins."
  • Cells overlap each other.
  • Stacked-coin morphology is noted throughout the peripheral blood smear.
  • Conditions associated with increased concentrations of globulins and/or fibrinogen
  • Hyperparaproteinemias
  • Waldenstrom macroglobulinemia
  • Multiple myeloma
  • Chronic inflammatory disorders
  • Clusters of RBCs due to antigen/antibody reactions in vivio
  • Cannot distinguish the outlines of individual RBCs
  • Cold agglutinins (most often IgM antibodies)
  • Paroxysmal cold hemoglobinuria