Red blood cells (RBCs) -- erythrocytes -- suspended in plasma tend to aggregate and form rouleaux. During aggregation the first stage consists in the formation of RBC doublets [Blood cells, molecules, and diseases 25, 339 (1999)]. While aggregates are normally dissociated by moderate flow stresses, under some pathological conditions the aggregation becomes irreversible, which leads to high blood viscosity and vessel occlusion. We perform here two-dimensional simulations to study the doublet dynamics under shear flow in different conditions and its impact on rheology. We sum up our results on the dynamics of doublet in a rich phase diagram in the parameter space (flow strength, adhesion energy) showing four different types of doublet configurations and dynamics. We find that membrane tank-treading plays an important role in doublet disaggregation, in agreement with experiments on RBCs. A remarkable feature found here is that when a single cell performs tumbling (by increasing vesicle internal viscosity) the doublet formed due to adhesion (even very weak) remains stable even under a very strong shear rate. It is seen in this regime that an increase of shear rate induces an adaptation of the doublet conformation allowing the aggregate to resist cell-cell detachment. We show that the normalized effective viscosity of doublet suspension increases significantly with the adhesion energy, a fact which should affect blood perfusion in microcirculation.
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