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The valence of the microorganisms could be decided by urgent evenly on the cowl slip with a pointed object just like the tip of a pen. When red blood cells develop into infested with the higher valence development forms of the first parasite, their urge to merge pulls the RBCs together. Copulation between excessive valence microorganisms on adjoining RBC membranes account for the rouleau formations. The presence of massive rouleau could be detrimental to patients suffering from occlusive vascular diseases as it causes impairment of blood movement in the small vessels that can compromise the purple blood cells’ potential to change carbon dioxide and oxygen gases. This can cause higher blood pressure so as to extend the availability of blood and oxygen to the tissue. Peripheral blood smears show rouleau when elements that enhance ESR (erythrocyte sedimentation fee) are current. Anemia, by increasing the ratio of RBCs to plasma, increases rouleau formation and accelerates sedimentation.

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