Pseudo-Grey Platelet Syndrome: A Rare Artifact

Abstract

Two cases that were identified during routine blood examination, presented an artifact the pseudo-grey platelet syndrome. The platelets from the blood collected with ethylene diamine tetra-acetic acid (EDTA) stained poorly on the blood smear and appeared agranular under the microscope. This artifactual anomaly did not occur when samples were collected in vacutainers containing citrate or collected by finger prick. Reports of pseudo-grey platelet syndrome are few, possibly because of the poorly explained and difficult to diagnose phenomenon.

The mismatch between Sysmex XN‐20 automated hematology analyzers and the visual examination of blood smears—Misclassification of hypogranular eosinophils and platelets

“…7 On the other hand, a rare ethylene diamine tetra-acetic acid (EDTA)dependent phenomenon, also called "pseudo-GPS," causes platelets to release the contents of alpha and delta granules in vitro, resulting in a gray appearance on the peripheral blood film as has been reported in a series of publications. 8 In addition to gray platelets, peripheral blood smears in peseudo-GPS patients may also show platelet aggregations. 4 Given this patient's lack of a history of abnormal bleeding as well as the observation of platelet aggregations on her peripheral blood smear, the abundant gray platelets on the film are more likely due to an EDTA-induced phenomenon rather than an underlying inherited disorder like GPS.…”