Basis of rouleaux formation

Q: What's the basis of Rouleaux formation in diseases with increased levels of plasma proteins?

Answer: When red blood cells (RBCs) stack together, like a stack of coins, it's called a Rouleaux formation.

Rouleaux formation is reported in many diseases with increased plasma protein levels, such as multiple myeloma, Waldenström's macroglobulinemia, inflammatory disorders, and high fibrinogen and immunoglobulin levels. These proteins neutralize the normally repulsive negative charges on the RBC membranes, causing them to adhere like a stack of coins.

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References:

1. Abramson N. Rouleaux formation. Blood. 2006 Jun 1;107(11):4205. PMID: 16739263.

2. Skalak R, Zarda PR, Jan KM, Chien S. Mechanics of Rouleau formation. Biophys J. 1981 Sep;35(3):771-81. doi: 10.1016/S0006-3495(81)84826-6. PMID: 7272459; PMCID: PMC1327562.

3. Chien S, Jan K. Ultrastructural basis of the mechanism of rouleaux formation. Microvasc Res. 1973 Mar;5(2):155-66. doi: 10.1016/0026-2862(73)90068-x. PMID: 4694282.

Picture source: Baker, W. Morrant, Harris, Vincent Dormer Kirkes, William Senhouse - Hand-book of physiology. 13th ed., Year: 1892 (1890s), Publisher: London : John Murray. Contributing Library: Francis A. Countway Library of Medicine