Ah yes, I remember seeing that.
In before the $hot $hill$.
If they wanted to be particularly honest, they could present differential diagnosis for any other syndromes causing rouleaux.
And then talk about the % of a person’s red blood cells affected and for how long.
Off the top of my head:
1. Multiple Myeloma
2. Waldensteoms disease
3. Hyperproteinemia of any source
It’s a not uncommon pathological finding on a peripheral smear.