Money roll formation

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Rolls of money in the blood smear
Roll formation (drawing)

With the term rouleaux formation , Rouleau formation or pseudoagglutination (Engl. Rouleau formation ) the reversible formation of chain-like stacking of red blood cells (will erythrocytes ), respectively. Red blood cells are deformable bodies with a biconcave shape about 7 µm in diameter, which in this case can stick to one another. Such chains of red blood cells can also be branched and in rarer cases form rings and loops. At the beginning of the roll formation, two erythrocytes form pairs. Cohesion is also used here. Roll formation and disintegration back into individual erythrocytes can take place in a few seconds. In some animal species (for example horses) there is often a roll formation in the blood.

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

Origin and meaning

A small amount of money rolls is a normal process in the human body, so red blood cells of this type are also found in small amounts in the human blood smear . Increased pseudoagglutination occurs particularly when the blood flow rate decreases. This is the case in the smallest end arteries ( capillaries ) or in the fine branches in the venous limbs of the blood circulation. Even after the onset of blood clotting, money rolls can form, i.e. in the fresh blood after blood has been drawn. This phenomenon has long been known in medicine (especially in transfusion medicine) and has no disease value. The ability to form money rolls is even to be regarded as an indication of “healthy blood” in the sense of a physiological coagulation status.

The adherence of the individual red blood cells is known to be promoted by the following substances or conditions:

After blood has been drawn, the drying up of the blood also leads to the formation of money rolls and, with appropriate tests, can lead to a positive test result even in healthy people. Warming blood samples also increases the likelihood of this phenomenon.

The chain formation influences the sedimentation rate (ESR) and is to be regarded as one of the mechanisms for regulating the viscosity and thixotropic properties of the blood. According to Fabry (see below), aggregation is a prerequisite for red blood cell sedimentation. The chain formation increases the viscosity of the blood and can lead to a downright clogging of the capillaries, one of the protective mechanisms against bleeding to death. The term “blood mud” is also used here ( sludge ). The increase in viscosity is the starting point for some methods for the quantitative determination of the roll formation. The most common is laser reflectometry. The Rheoskopie describes under standardized conditions the rouleaux formation under a microscope in vivo .

On the other hand, the sticking together of the blood cells reduces the total surface area of ​​the blood cells available for oxygen transport. This can lead to a local reduction in the oxygen supply in the affected supply area.

Pathologically increased roll formation in the blood count is found in thalassemia , multiple myeloma , Waldenström's disease , inflammatory diseases, collagenoses and polyglobules . During pregnancy, too, the red blood cells can temporarily increase their roll formation. It also occurs in diabetes and is the cause of the microvascular occlusions in diabetic retinopathy.

The formation of money rolls in alternative medicine

In contrast to scientific medicine, in alternative medicine the view is held in some places that the formation of money rolls is to be regarded as an obligatory pathological event and that the observation of this phenomenon is generally suitable for the diagnosis of a number of diseases, not including thalassemia and polyglobulias.

A non-standardized and mostly insufficiently precisely described, purely qualitative application of dark field microscopy for observing the formation of a roll of money is often used . Corresponding blood tests have become known as dark field vital blood diagnostics . Evidence of the diagnostic specificity is still pending. The corresponding costs are not reimbursed by the health insurance companies .

The tests mentioned above are sometimes used to detect alleged damage to the blood by electromagnetic fields (EMF). Here, too, there are no scientific studies that would document that the purely qualitative description of the formation of money rolls in red blood cells would be a sign of damage to the blood or that this would occur in the presence of EMF. Since the formation of money rolls can show up in the blood smear even in completely healthy people, this method is not meaningful with regard to possible influences of electromagnetic fields on the human organism.

In the case of a network-like ramification of money rolls, the term “filit formation” is also used in alternative medicine. The term filit , however, goes back to the views of the zoologist Günther Enderlein , who at the beginning of the 20th century had developed a theory about the pleomorphism of microbes that has since been refuted .

Likewise, the claim that over-acidification of the blood leads to a "typical" roll formation is scientifically not tenable. This claim can be found e.g. B. in certain guides on "purification".

literature

  • CR Huang: Thixotropic properties of whole blood from healthy human subjects. In: Biorheology. 24 (6), 1987, pp. 795-801.
  • RW Samsel, AS Perelson: Kinetics of rouleau formation. I. A mass action approach with geometric features. In: Biophys J. 37 (2), Feb 1982, pp 493-514.
  • RW Samsel, AS Perelson: Kinetics of rouleau formation. II. Reversible reactions. In: Biophys J. 45 (4), Apr 1984, pp. 805-824.
  • JF Stoltz, S. Gaillard, F. Paulus, O. Henri, P. Dixneuf: Experimental approach to rouleau formation. Comparison of three methods. In: Biorheology. Suppl. 1, 1984, pp. 221-226.
  • TL Fabry: Mechanism of erythrocyte aggregation and sedimentation. In: Blood. 70 (5), Nov 1987, pp. 1572-1576.

See also

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