Piastrine grigie sullo striscio di sangue periferico: patologia o artefatto?

AUTORI

ABSTRACT

Gray platelets on peripheral blood smear: syndrome or artifact?

This case reports on a 6-year-old child, suffering from phenylketonuria treated with levetiracetam. The complete blood count showed degranulated platelets, confirmed by optical microscopy of the peripheral blood smear. Medical history revealed no bleeding or thrombocytopenia, so a correlation between the phenomenon and the pharmacological treatment was postulated. However, among the adverse effect of this drug, only cases of drug-induced thrombocytopenia are known. From a literature research, we were able to retrieve a description of a “pseudo gray platelet syndrome induced by EDTA”. The blood sampling was thus repeated using sodium-citrate as anticoagulant besides EDTA; smears were performed using these samples and directly from a finger stick. The smear from the EDTA sample confirmed the presence of degranulated platelets; while the one from the sodium-citrate sample showed no platelet abnormalities. Platelet morphology was also normal in the smear from the finger stick. Pseudo Gray Syndrome Platelet (PGSP) by EDTA is an “in vitro” phenomenon not associated with bleeding disorders. The observation of different peripheral blood smears (EDTA, sodium-citrate and finger stick) allowed us to correctly identified a harmless condition, distinguishing it from the true gray platelet syndrome, a much more severe disorder.

BIBLIOGRAFIA