The influence of the micro-roughened surface, produced by dual acid-etching (DAE) of machined commercially pure titanium, on initial blood cell/implant interactions was investigated by observing the blood components remaining at the implant surface following freeze-fracture of clotted, and fixed, human blood. Glass surfaces were also used for immunolabelling studies to identify fibrin and platelets. The interface comprised predominantly fibrin and red blood cells (RBCs). The difference in distribution of RBCs was statistically significant (P < 0.05) at 10 min of blood/implant contact, but diminished thereafter. Micro-roughened DAE implant surfaces showed, qualitative, more platelets than machined surfaces, while the textured glass surfaces demonstrated increased platelet aggregation. We believe that these early blood cell/implant interactions may play a key role in the osteoconduction stage of peri-implant bone healing response to micro-roughened implants.