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<br> The valence of the microorganisms will be determined by urgent evenly on the cowl slip with a pointed object like the tip of a pen. When pink blood cells turn out to be infested with the upper valence growth types of the primary parasite, their urge to merge pulls the RBCs collectively. Copulation between high valence microorganisms on adjoining RBC membranes account for the rouleau formations. The presence of huge rouleau could be detrimental to patients affected by occlusive vascular diseases as it causes impairment of blood move in the small vessels that may compromise the red blood cells’ capacity to alternate carbon dioxide and oxygen gases. This can cause higher blood pressure so as to increase the provision of blood and oxygen to the tissue. Peripheral blood smears show rouleau when factors that enhance ESR (erythrocyte sedimentation price) are current. Anemia, by increasing the ratio of RBCs to plasma, increases rouleau formation and accelerates sedimentation.<br>
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