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Rouleaux formation on patient vaginal swab wet smear. Conditions that cause rouleaux formation include infections, multiple myeloma, Waldenström's macroglobulinemia, inflammatory and connective tissue disorders, and cancers. It also occurs in diabetes mellitus and is one of the causative factors for microvascular occlusion in diabetic retinopathy.
Erythrocyte aggregation is a physiological phenomenon that takes places in normal blood under low-flow conditions or at stasis. The presence or increased concentrations of acute phase proteins, particularly fibrinogen, results in enhanced erythrocyte aggregation.
Rouleaux causes red blood cells to stack together, which can mimic agglutination, causing a false positive result in the reverse grouping. This can be avoided by removing the plasma, replacing it with saline, and re-centrifuging the tube. Rouleaux will disappear once the plasma is replaced with saline, but true agglutination will persist.
People may develop cold agglutinins from lymphoproliferative disorders, from infection with Mycoplasma pneumoniae or Epstein–Barr virus, or idiopathically (without any apparent cause). Red cell agglutination can also occur in paroxysmal nocturnal hemoglobinuria [2]: 13 [3] and warm autoimmune hemolytic anemia.
(c) The migration of blood cells from the tube wall to the axis depends on the particle size and not on the particle density. (d) At low flow rates, the red cells aggregate into rouleaux and these being the largest particles in the suspension migrate to the axis forming a core that displaces the white cells to periphery.
This phenomenon causes red blood cells to clump together because of antibodies bound to the cell surface. [196] Red blood cell aggregates are counted as single cells by the analyzer, leading to a markedly decreased red blood cell count and hematocrit, and markedly elevated MCV and MCHC (mean corpuscular hemoglobin concentration). [53]
Alder–Reilly anomaly, or Alder anomaly, is an inherited abnormality of white blood cells associated with mucopolysaccharidosis.When blood smears and bone marrow preparations from patients with Alder–Reilly anomaly are stained and examined microscopically, large, coarse granules may be seen in their neutrophils, monocytes, and lymphocytes.
Expansion of the cyst causes erosion of the floor of the maxillary sinus. As soon as it enters the maxillary antrum, the expansion rate increases due to available space for expansion. Performing a percussion test by tapping the affected teeth will cause shooting pain. This is often clinically diagnostic of pulpal infection. [citation needed]