A well known physiological property of erythrocytes is that they can aggregate and form a rouleau. We present a theoretical analysis of erythrocyte shapes in a long rouleau composed of cells with identical sizes. The study is based on the area difference elasticity model of lipid membranes, and takes into consideration the adhesion of curved axisymmetric membranes. The analysis predicts that the erythrocytes in the rouleau can have either a discoid or a cup-like shape. These shapes are analogous to the discoid and stomatocyte shapes of free erythrocytes. The transitions between the discoid and cup-like shapes in the rouleau are characterized. The occurrence of these transitions depends on three model parameters: the cell relative volume, the preferred difference between the areas of the membrane bilayer leaflets, and the strength of the adhesion between the membranes. The cup-like shapes are favored at small relative volumes and small preferred area differences, and the discoid shapes are favored at large values of these parameters. Increased adhesion strength enlarges the contact area between the cells, flattens the cells, and consequently promotes the discoid shapes.
Derganc, J., Božič, B., Svetina, S., & Žekš, B. (2003). Equilibrium shapes of erythrocytes in rouleau formation. Biophysical Journal, 84(3), 1486–1492. https://doi.org/10.1016/S0006-3495(03)74961-3