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.
See also Dr. Charles Hoffe, who had jabbed over 900 patients and noted they began reporting headaches and reduce maximal exercise levels (one elderly patient who had been walking 2 miles to see him every week, who suddenly couldn't walk more than a quarter mile).
He started doing before-and-after-the-jab tests of d-Dimer, and found 62% of those injected showed abnormally high levels after the jab.
Unless you want to posit they all magically developed undiagnosed cancer after their first blood test.
Also there are a number of pathologists who report spike proteins all over the body upon autopsy of those who died shortly after the jabs.