a. What does the blood film show?

b. List some haematological condition which 
    may be responsible for this appearance.
 
c. What ocular signs may be present?
 

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This is the blood film of a patient with blurred vision.

a. What does the blood film show?

Rouleaux formation.
The red blood cells stacked together like coins and this occurs with increased serum proteins especially fibrinogen and globulins. These long chains of red blood cells allows the cells to sediment more rapidly and therefore high ESR (erythrocyte sediment rate). 

b. List some haematological condition which may be responsible 
    for this appearance.

• multiple myeloma
• Waldenstrom's macroglobulinaemia

c. What ocular signs may be present?

Posterior segment

• tortuous veins
• retinal haemorrhages
• retinal vein occlusion

Neuro-ophthalmic signs

• papilloedema
• cranial nerve palsies

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