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When rouleaux formation is truly present, it is caused by an increase in cathodal proteins, such as immunoglobulins and fibrinogen.
And the fibrinogen is not present in blood in vivo


*This is not true. Fibrinogen is secreted by liver and is present in blood. The reason rouleaux do not form in vivo is that they only form under low shear stress conditions. With blood flow, the cross-sectional fluid velocity gradient in the blood vessel results in shear stress levels that exceed the threshold for rouleaux formation.

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Q: Why rouleaux formation does not occur in vivo?
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What causes rouleaux formation?

The red blood cells stack up like coins. http://en.wikipedia.org/wiki/Rouleaux


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Autoagglutination should also be distinguished from "Rouleaux formation" wherein normal blood tends to form stacks on keeping, which disperses on dilution with normal saline.


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