Spot Diagnosis: Name this finding on blood film. Name one condition that is associated with this finding on blood film.

Answer: Rouleaux. Rouleaux are stacks of red blood cells that form when plasma protein levels are high, causing the flat surface of the discoid shaped red blood cells to stick together. Rouleaux can be seen in medical conditions such as multiple myeloma, infections, inflammatory and connective tissue disorders, and malignancies.