Rouleaux

By the term the formation of rouleaux, rouleaux formation or pseudoagglutination (English rouleau formation ) the reversible formation of chain-like stacking of red blood cells (erythrocytes) is called. Red blood cells are biconcave deformable body having the form of approximately 7 microns in diameter, which can adhere to each other in this case. Such chains of red blood cells may also be branched and form rings and loops in rarer cases. At the beginning of the formation of rouleaux it comes to pairing two erythrocytes. Here is also spoken by cohesion. A rouleaux formation and decay back into individual erythrocytes can be done in a few seconds. In some species (eg horses ), there is often a rouleaux formation in the blood.

The chain developments can be seen in the light microscope, phase contrast microscope or with the dark-field microscopy.

Origin and Meaning

A small rouleaux formation in the human body is a normal process, hence such rouleaux of red blood cells found in the blood smear of man to a small extent. An increased pseudoagglutination takes place in particular when the flow rate of the blood decreases. This is the case in small terminal arteries (capillaries ) or in the fine ramifications in the venous limb of the blood circulation. Even after the onset of bleeding may occur rouleaux formation, ie in fresh blood after blood collection. This phenomenon has long been known in medicine (especially in transfusion medicine) and has no clinical significance. The ability to rouleaux formation is to be regarded even as a sign of " healthy blood " in the sense of physiological coagulation status.

The clash adhesion of individual red blood cells is known to be stimulated by the following substances or conditions:

• Dysproteinaemia ( increased incidence of high molecular weight plasma proteins ( proteins) such as fibrinogen)
• Alpha2 globulins
• Immunoglobulins in high concentration ( paraproteinemia )
• Albumin
• Polylysine
• Dextrans
• High platelet concentration

After collection, the drying of blood also leads to the formation of rouleaux and can lead to a positive test result in corresponding tests in healthy people. Heating of blood samples also increases the likelihood of this phenomenon.

The chain formation influences the erythrocyte sedimentation rate (ESR) and is considered to be one of the mechanisms for controlling the viscosity and thixotropic properties of blood. According to Fabry (see below) is the aggregation condition for the sedimentation of red blood cells. By chaining the viscosity of the blood is increased, and there may be a real blockage of the capillaries, one of the protective mechanisms from bleeding to death. Here is then spoken of " blood sludge " ( engl. sludge ). The increase in viscosity is the starting point of some methods for the quantitative determination of rouleaux formation. The most common is the laser reflectometry. The Rheoskopie describes under standardized conditions, the rouleaux formation under the microscope in vivo.

On the other hand, is reduced by the bonding of the available blood cells to transport oxygen blood cell total surface area. This can lead to a local reduction in oxygen supply in the affected service area.

Pathologically increased rouleaux formation in the blood picture is found in the diseases of thalassemia and polycythemia. Even in pregnancy, it may be a temporary increased rouleaux formation of red blood cells.

The rouleaux formation in alternative medicine

Unlike in scientific medicine is in some places represented in alternative medicine the view that the rouleaux formation should be regarded as an obligate pathological events and the observation of this phenomenon generally lend itself to the diagnosis of a number of diseases in which case the thalassemias and polyglobulias are not meant.

It is often resorted to a non-standard and usually insufficient accurately defined purely qualitative application of dark field microscopy for the observation of the formation of rouleaux. Appropriate blood tests have become known as darkfield Vital blood diagnostics. Proof of diagnostic specificity is still pending. The related costs are not reimbursed by health insurance.

In the above tests is sometimes resorted to in order to prove an injury to the blood through electromagnetic fields ( EMF). Again, there are no scientific studies that would show evidence that the purely qualitative description of a rouleaux formation of red blood cells would be a sign of damage to the blood, or this would ever occur in the presence of EMF only. As can be shown even in completely healthy people a rouleaux formation in blood smears, this method is not meaningful in terms of the potential impact of electromagnetic fields on the human organism.

For a network -like branched rouleaux formation is spoken in the alternative medical field by a " Filitbildung ". However, the term Filit goes back to the zoologist Günther Enderlein views, which had developed at the beginning of the 20th century a now discredited theory of pleomorphism of microbes.

Likewise, the assertion that an acidification of the blood leads to a "typical" rouleaux formation, with no scientific basis. This assertion is, for example, to in certain advisers to "cleanse".