1. Check that all serum tests are "positive" (2+ or less).
  2. Check microscopically for "coin stacks."
  3. Check the diagnosis for diseases such as multiple myeloma.
  4. Check for infusions of substances such as dextran or PVP.
  5. Try to disperse the rouleaux using the serum replacement method: Centrifuge the test tube, remove the serum and replace it with an equivalent amount of saline. Re-read the test. Rouleaux should disperse to give a negative result.

    Note: Saline replacement is appropriate only when the serological pattern fits rouleaux.

©1999 Division of Medical Laboratory Science
University of Alberta