MCL Blood Cell Atlas
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-Four or more red blood cells simulating a stack of coins.

-Must differentiate true rouleaux from artifact that is found in the thick portion of all blood smears and from agglutination.

-True rouleaux is due to hyperproteinemia and is noted in the thin area of a well made smear.

-A tip-off to rouleaux is blue staining background (proteinaceous) which is seen macroscopically.

Rouleaux : 1000X