Platelet dense granules are membrane bound compartments that store polyphosphate and small molecules such as ADP, ATP, Ca2+ and serotonin. The release of dense granule contents plays a central role in platelet aggregation to form a hemostatic plug. Accordingly, congenital deficiencies in the biogenesis of platelet dense granules underlie human genetic disorders that cause storage pool disease and manifest with prolonged bleeding. Dense granules belong to a family of lysosome-related organelles, which also includes melanosomes, the compartments where the melanin pigments are synthesized. These organelles share several characteristics including an acidic lumen and, at least in part, the molecular machinery involved in their biogenesis. As a result, many genes affect both dense granule and melanosome biogenesis and the corresponding patients present not only with bleeding but also with oculocutaneous albinism. The identification and characterization of such genes has been instrumental in dissecting the pathways responsible for organelle biogenesis. Because the study of melanosome biogenesis has advanced more rapidly, this knowledge has been extrapolat ed to explain how dense granules are produced. However, some progress has recently been made in studying platelet dense granule biogenesis directly in megakaryocytes and megakaryocytoid cells. Dense granules originate from an endosomal intermediate compartment, the multivesicular body. Maturation and differentiation into a dense granule begins when newly synthesized dense granule specific proteins are delivered from early/recycling endosomal compartments. The machinery that orchestrates this vesicular trafficking is composed of a combination of both ubiquitous and cell type specific proteins. Here we review the current knowledge on dense granule biogenesis. In particular, we focus on the individual human and murine genes encoding the molecular machinery involved in this process and how their deficiencies result in disease.