rouleaux would show as a high esr
I put some time into researching this. My conclusion:
a good ESR is indeed a valid means to exclude rouleaux.
Details:
The most convincing point I found was this:
Rouleaux formation is a core part of the erythrocyte sedimentation process! So when rouleaux are already preformed, then a part of the sedimentation process is already accomplished:
https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate
There are 3 stages in erythrocyte sedimentation
1) Stage 1 : Rouleaux formation - First 10 minutes
2) Stage 2 : Sedimentation or settling stage - 40 mins
3) Stage 3 : Packing stage - 10 minutes (sedimentation slows and cells start to pack at the bottom of the tube)
Clear statements:
http://www.cell.com/biophysj/fulltext/S0006-3495(04)73889-8
" In medical practice, RBC aggregation is usually measured indirectly via the erythrocyte sedimentation rate (ESR),"
https://en.wikipedia.org/wiki/Erythrocyte_aggregation
Erythrocyte sedimentation rate closely reflects the extent of aggregation, therefore can be used as a measure of aggregation.
Unless some further arguments arrive, for me the above settles the question about ESR and rouleaux: A good ESR excludes rouleaux. -> Think no further. Get tested!
Additionally, the following might be of interest to the relationship of rouleaux and CFS: Rouleaux (= rbc aggregates) cause high blood pressure:
http://www.sciencedirect.com/science/article/pii/S0026286283710216
But we know that the majority of CFS patients struggle with low BP!
So, this is not a typical rouleaux-like situation, though obviously this argument doesnt exclude it. ESR does. Generally about high viscosity: Imagine you have to press honey (high viscosity) through a small hole. That wont work without using a lot of force... Ever tried this? When I was a child, my parents always bought this lovely honey bear at the right. You see it has a thin tip. When it came from the shop, one needed to cut the tip with a scissor so the honey came out. Now, I sometimes made a mistake: I cut too little, so the hole was very small. In this case it was damn difficult to get out the honey. But at the end of using up the honey, we added some lukewarm water to dissolve the last bits of honey clinging to the bear's inner walls. Now, this water got out easily even if the opening at the tip was cut too small. So I learned this way what viscosity is and that a high viscosity necessitates a big pressure!
Question:
When a person has a good ESR and no elevated fibrinogen like me, then what on earth can be the pleasant improvement effect from fibrinolytic agents such as bromelain or nattokinase? Their action on dismantling biofilms is not likely to make anyone feel well!
As of today, I get horrible chills from nattokinase. This is logical. But earlier, I felt well for several days on it before I had to stop. At no time I had a bad ESR nor CRP. And at all times a lowish BP. My fibrinogen was measured back when I profitted from nattokinase and it was as good as can be: 2.9 (1.5-4.0 g/L).
And I do not at all understand this change in the reaction...