The gray platelet syndrome (GPS) is a rare congenital bleeding disorder in which thrombocytopenia is associated with increased platelet size and decreased ␣-granule content. This report describes 3 new pediatric cases presenting with the classical platelet abnormalities of GPS within one family with normal parents. Examination of blood smears of the 3 patients demonstrated not only gray platelets, but also gray polymorphonuclear neutrophils (PMNs) with decreased or abnormally distributed components of secretory compartments (alkaline phosphatase, CD35, CD11b/CD18). Secondary granules were also decreased in number as assayed by immunoelectron microscopy. These data confirm that the secretory compartments in neutrophils were also deficient in this family. Megakaryocytes (MKs) were cultured from the peripheral blood CD34 ؉ cells of the 3 patients for 14 days, in the presence of thrombopoietin and processed for immunoelectron microscopy. Although von Willebrand factor (vWF) was virtually undetectable in platelets, vWF immunolabeling was conspicuous in cultured maturing MKs, particularly within Golgi saccules, but instead of being packaged in ␣-granules, it was released into the demarcation membrane system. In contrast, P-selectin followed a more classical pathway. Double-labeling experiments confirmed that vWF was following an intracellular pathway distinct from the one of Pselectin. In these 3 new cases of GPS, the MKs appeared to abnormally process vWF, with secretion into the extracellular space instead of normal ␣-granule packaging. Furthermore, the secretory compartment of another blood cell line, the neutrophil, was also affected in this family of GPS.
IntroductionThe gray platelet syndrome (GPS) is an inherited disorder of primary hemostasis with associated bleeding tendency, thrombocytopenia, and classical abnormal platelet morphology. 1 The platelets appear characteristically gray after Romanovsky staining as a result of an abnormally low ␣-granule content. Immunoelectron microscopic analysis of gray platelets confirms that the ␣-granule contents appear absent. 2 In contrast, the granule-limiting membranes appear present with normally expressed protein components. 3 This syndrome is distinct from other inherited disorders that also affect platelet ␣-granules, such as ␣-␦ storage pool deficiency and the Quebec platelet disorder. The former is combined with dense granule deficiency 4 and the latter with an abnormal protease activity responsible for ␣-granule protein degradation. 5 The ␣-granules are the principal storage site for hemostatic proteins such as fibrinogen, von Willebrand factor (vWF), thrombospondin, and factor V and for growth factors such as platelet-derived growth factor and transforming growth factor-. 6 In addition, plasma proteins such as albumin and immunoglobulins are endocytosed by platelets and stored in ␣-granules. 7 The ␣-granule proteins are released into the open canalicular system on platelet activation and play a key role both in hemostasis and wound healing. In this report, we ...