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The supply of oxygen and nutrients and the disposal of metabolic waste in theorgans depend strongly on how blood, especially red blood cells, flow throughthe microvascular network. Macromolecular plasma proteins such as fibrinogencause red blood cells to form large aggregates, called rouleaux, which areusually assumed to be disaggregated in the circulation due to the shear forcespresent in bulk flow. This leads to the assumption that rouleaux formation isonly relevant in the venule network and in arterioles at low shear rates orstasis. Thanks to an excellent agreement between combined experimental andnumerical approaches, we show that despite the large shear rates present inmicrocapillaries, the presence of either fibrinogen or the synthetic polymerdextran leads to an enhanced formation of robust clusters of red blood cells,even at haematocrits as low as 1%. Robust aggregates are shown to exist inmicrocapillaries even for fibrinogen concentrations within the healthyphysiological range. These persistent aggregates should strongly affect celldistribution and blood perfusion in the microvasculature, with putativeimplications for blood disorders even within apparently asymptomatic subjects.

The plasma protein fibrinogen stabilizes clusters of red blood cells in microcapillary flows