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Rouleaux cells and reactive lymphocytes are signs of inflammation. During my son's bout with Aplastic Anema, each upper respiratory virus and common cold would cause his c-reactive protein to go up, Rouleaux cells and acanthrocytes would show up in his blood cells, and his erythrocyte sedimentation rate would increase. While this was happening his blood numbers would crash. Then as he got over the virus the weird cells would go away and his blood numbers would go up again (still low, but to whatever it had been the week prior.) He's had reactive lymphocytes show up 5 or 6 times since diagnosis, ranging from 4 to 7%, starting with when he was diagnosed in the hospital in Apr 2013. So whatever is causing his aplastic anemia is also causing the reactive lymphocytes, which is probably the inflammation that comes along with them.
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