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Other common features of MM include stacked RBCs, also known as a rouleaux formation,found on peripheral blood smears and shown here. Excessive production of immunoglobulins also produces a characteristic M spike on urine electrophoresis. Excess serum proteins lead to hyperviscosity and cause circulating RBCs to adhere to themselves, leading to the rouleaux (“roll of coins”) appearance. The most common abnormal immunoglobulin produced is IgG.