Erythrocyte aggregation is a finding similar to rouleau, however, it is more serious as it results in greater impairment in oxygen and carbon dioxide exchange because of its ability to occlude larger microvascular elements through increased red cell mass. There are several pathological causes for increased attraction between the red cells and most are due to alterations in the plasma environment. Red cell sludging (agglutinated erythrocytes) may form as a result of alterations of the cell surface membrane which exhibits the tendency to adhere to adjacent cell membranes. Lipoproteins, fats and acute phase proteins have been implicated in the production of blood sludge in addition to increased dietary ingestion of fat, altered blood lipid chemistry and hypercholesterolemia.
red_blood_cell_aggregation

Red cell aggregation is totally absent in the healthy subject and is a contributing factor in at least 50 different pathological conditions and diseases. Agglutination makes the red
cells more susceptible to phagocytic activity by the spleen and liver, thus reducing the number of circulating cells and impairing the blood’s oxygen carrying capacity. The pathogenesis of myocardial infarction, anginal disease, neoplastic problems, atherosclerotic processes and venous thrombosis has been reliably linked to severe red cell aggregation. Correlation between blood viscosity and erythrocyte aggregation has been found important in the survival of patients suffering from malignant melanoma.

By all means, it is imperative that follow-up laboratory work be ordered to determine the underlying cause of this finding.
The following blood tests should be ordered:

Complete multi-channel blood profile, CBC with differential, coagulation time, thyroid profile, and additional blood tests as indicated by the history, symptoms and physical findings.

Circulatory studies may be necessary including plethysmographic and doppler evaluation, electrocardiography and phonocardiography.

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