Artifactual Poikilocytosis
Another example of rouleaux is seen in this slide taken from a patient with multiple myeloma. Frequently, the darkly stained macroscopic appearance of the slide will be a clue to the presence of rouleaux on the smear. Increased globulins in the plasma oftne cause the background of the stained smear to be somewhat bluer than the other slides stained at the same time.