What are Rouleaux?

Rouleaux are stacks of red blood cells that form as a response to some sort of infection or other problem with a person’s blood chemistry. The condition is usually considered problematic and can lead to a number of different health complications. Under normal circumstances red blood cells, also called erythrocytes, are wholly independent and flow through the blood stream on their own bringing oxygen and other nutrients from one place to the next. When they clump or stack up together, they tend to move a lot more slowly and may not be able to be as effective. There are a number of reasons why a person’s cells might do this, but infection, diabetes, and certain cancers are some of the most common causes. Medical experts will often look for this condition when people complain of fatigue, poor circulation, and persistent dizziness, and in most cases it's fairly treatable with certain lifestyle changes or oxygen therapy.

The primary job of a red blood cell is to transport oxygen throughout the body. When the cells can't float freely, they can't perform this job properly, which can result in illness and disease. Healthy red blood cells are usually round in shape and often have the appearance of a squished sphere; some people refer to the shape as similar to a donut with the center filled in. They usually travel one by one, but they sometimes form chains or stacks, both of which tend to be problematic. A single stack of three or more red blood cells is called a rouleau, and may not be an issue on its own. When the blood is full of these stacks, which are often said to resemble rolled coins, the consequences can be very serious.

In most cases, red blood cells clump together like this when the blood has a lot of protein in it. Usually, the high concentration of protein is of one of two types — fibrinogen or globulins. Both of these proteins are produced in the liver. Nailing down a precise reason why this happens is often more difficult.

Stacking is often an indication of inflammation in the body, though this can be caused by many different things. Possibilities include acute and chronic infections, inflammatory and connective tissue disorders, chronic liver disease, and cancers such as myeloma. Rouleaux also sometimes occur in people who have diabetes. In these cases the condition can cause small blood vessels in the eyes to become damaged, which can lead to what is known as diabetic retinopathy. Patients receiving intravenous therapy with high molecular weight fluids, such as fibrinogen, may also have cells that stack rather than float.

People suffering from allergies and those who have undergone severe trauma may also exhibit the condition. In these cases the problem is most commonly a reaction to a temporary shift in blood chemistry or volume and it will usually resolve itself, but not always. A lot depends on the individual and the extent of the triggering problem.

The primary symptoms of rouleaux include fatigue, poor circulation to the hands and feet, and dizziness. These are rather general things, though, and in most cases they don’t indicate anything specific on their own. Doctors and other medical professionals usually have to screen a patient’s blood very carefully to see if any stacks or other abnormalities are visible. Identification is usually made by analyzing a blood sample under a microscope.

Treatment for rouleaux varies. Natural remedies, such as nutritional supplements, may work for some people, and patients with minor cases or cases that are believed to be temporary might be able to “wait it out” and let things resolve themselves naturally. For others, though, medical interventions and therapies may be required.

Some studies show that ozone therapy prevents stacks from forming. People undergoing this sort of treatment typically receive a mixture of ozone and oxygen through an intramuscular injection, through the rectum, or intravenously. The intravenous route requires some of the patient's blood to be removed, treated with an oxygen and ozone mixture, and then reintroduced into the patient. This sort of therapy can solve the problem in just a few sessions in some people, but in others it becomes something that has to be repeated on a regular basis for years in order to keep stacks from forming.