(American Society of Hematology).
The appearance of rouleaux may be artificially caused by a poor preparation of the smear or by viewing the slide in a thickened area.
Sounds like you or your co-workers need to brush up on your techniaque.
When rouleaux formation is truly present, it is caused by an increase in cathodal proteins, such as immunoglobulins and fibrinogen.
Fibrinogen.
Oh yeah. No wonder they call it the Clot Shot.
I would suspect we would also see supportive clinical signs and symptoms if rouleaux is truly present..as in coagulopathies leading to strokes or DIC or that occur with sepsis.