The rheological aspects of red blood cell aggregation include molecular phenomena, cell viscoelasticity, and bulk flow rheology. At the molecular level, rates at which bonds are formed and broken, the chemical energy liberation from bond formation, the elasticity of the cross-bridges and lateral mobility of cross-linking molecules must all be considered for a complete description of bond formation and distribution. Lateral migration of binding molecules occurs due to diffusion in the surface of the membrane but may also be influenced by the stresses in the membrane during separation of adhering cells. In red blood cell disaggregation, fluorescent probes have shown concentration of ligands in the region of contact close to the line of separation. The chemical potential decrement that occurs when a bond is formed provides the energy source that may deform red blood cells in the process of aggregation. The degree of aggregation and the extent of cell deformation depends on the viscoelastic properties of the cell as well as the dynamics of bond formation and repulsive potential of surface charges present, which is governed by an equation representing a balance of these energies. In flowing blood, the hydrodynamic forces applied by the plasma and surrounding cells must be added to the bond forces and elastic response of the cell. Under sufficiently strong aggregation, plug flow or large aggregates may result. At high shear rates, aggregation may be prevented due to the small contact time and high shear stresses so that no effects of aggregation may be observed. At intermediate shear stresses, transitory contact, adhesion and disaggregation may occur between neighboring cells. Such phenomena have not been analyzed in detail, but simplified models suggest that plug-like flow can occur due to hydrodynamic cell-cell interaction even when cells are not aggregated.