Immune Thrombocytopenic Purpura (ITP) in Grand Rapids, Michigan

Immune thrombocytopenic purpura (ITP) is a rare autoimmune blood disorder that causes low platelet levels. Platelets are tiny cell fragments in your blood that help it clot and stop bleeding. In ITP, your immune system mistakenly attacks and destroys these platelets, leading to an increased risk of bruising and bleeding.

Residents of Grand Rapids and West Michigan can access specialized care for ITP through major health systems such as Spectrum Health, Trinity Health Grand Rapids, Metro Health, and Mercy Health, as well as support from the Kent County Health Department and Grand Rapids Public Health.

What Is ITP?

In people with ITP, the immune system produces antibodies that attach to platelets and mark them for destruction, mainly in the spleen. Sometimes, certain white blood cells called T cells can directly destroy platelets as well.

Whether platelets are attacked by antibodies, T cells, or both, the result is the same: a low platelet count (thrombocytopenia).

There are two main types of ITP:

  • Acute ITP
  • Chronic ITP

Acute ITP

  • More common in children, often between 2–4 years of age
  • Accounts for about 9 out of 10 pediatric ITP cases
  • Frequently follows a viral infection, such as a cold or flu, which are common during Michigan’s fall and winter seasons
  • Usually resolves on its own within 2–6 months

Acute ITP is far less common in adults. Adults in the Grand Rapids area who develop ITP are more likely to have the chronic form.

Chronic ITP

  • More common in adults, especially young women
  • Has similar symptoms to acute ITP
  • Lasts longer than six months
  • May persist for years and require ongoing monitoring and treatment

How the Immune System Causes ITP

Your immune system normally distinguishes between “self” (your own tissues) and “non-self” (viruses, bacteria, and other foreign invaders). In autoimmune diseases like ITP, this recognition system breaks down.

Doctors believe that viral infections can sometimes trigger ITP. For reasons that are not fully understood:

  • Lymph tissue and the spleen start making abnormal antibodies that attach to platelets.
  • These antibodies are called autoantibodies because they attack your own cells.
  • Platelets coated with autoantibodies are destroyed faster than your body can replace them.

In many cases, the exact cause is unknown (idiopathic). When ITP is not linked to any other disease, it is called primary ITP. When it is associated with another condition, it is called secondary ITP.

Primary vs. Secondary ITP

  • Primary ITP

    • No other underlying disease is identified
    • Most common form in otherwise healthy children and adults

  • Secondary ITP

    • Occurs in association with:
      • Other autoimmune diseases (such as lupus or rheumatoid arthritis)
      • Chronic viral infections (such as HIV or hepatitis)
      • Primary immune deficiency
      • Certain medications
      • Some cancers

Platelets and Normal Counts

Platelets are made in the bone marrow, the spongy tissue inside your bones.

  • Normal platelet count:
    150,000–400,000 per microliter of blood (150–400 × 10⁹/L)

  • ITP platelet count:
    Often 20,000 per microliter (20 × 10⁹/L) or lower

In ITP:

  • The bone marrow usually makes normal “new” platelets.
  • The problem is that platelets are destroyed prematurely in the bloodstream and spleen.

In many cases of acute ITP, platelet counts rise again within a few weeks and return to normal within a few months.

Who Does ITP Affect?

ITP can affect anyone, including children and adults living in Grand Rapids and the broader West Michigan region.

  • Children

    • ITP affects about 1 in every 10,000 children
    • Most cases are acute and resolve on their own
    • Often follow a viral illness, which is common during Michigan’s colder months

  • Adults

    • ITP affects about 1 in 20,000 adults
    • More likely to have chronic ITP
    • Young women are affected more often than other adult groups, for reasons that are not fully understood

Symptoms of ITP

Many people in Grand Rapids with mild ITP have no symptoms and feel perfectly well. ITP is often discovered during routine blood tests done for another reason.

When platelet counts drop very low, symptoms can include:

  • Easy bruising or bruises that appear without clear injury
  • Petechiae – a rash of small, flat, red or purple dots on the skin
    • These do not blanch (turn pale) when pressed
  • Bleeding from the gums, especially after brushing or flossing
  • Frequent nosebleeds that are hard to stop
  • Prolonged bleeding from minor cuts
  • Heavy or long menstrual periods (in women)
  • Internal bleeding, which may cause:
    • Blood in urine or stool
    • Very dark or tar-like stool
    • Severe headache or confusion (rare but serious sign of bleeding in the brain)
  • Fatigue, which is common in ITP even though platelets themselves do not control energy levels

If you live in Grand Rapids and notice unexplained bruising, persistent nosebleeds, or other unusual bleeding, you should contact your primary care provider or seek care at a local emergency department (Spectrum Health, Trinity Health Grand Rapids, Metro Health, or Mercy Health).

Causes of ITP

The exact cause of ITP is still not fully understood. Current theories suggest:

  • Viral infections can make the immune system overactive.
  • The immune system begins to produce abnormal antibodies that attack platelets.
  • Some people may have a genetic predisposition to autoimmune reactions.

In many cases, no clear trigger is ever found.

How ITP Is Diagnosed in Grand Rapids

ITP is a diagnosis of exclusion, which means doctors must rule out other causes of low platelets before confirming ITP.

If a low platelet count is found on a blood test, your Grand Rapids healthcare provider may order:

Blood Tests

  • Full blood examination (FBE) / complete blood count (CBC)
    • To check platelet numbers and other blood cells
  • Peripheral blood smear
    • To see if blood cells look normal under a microscope
  • Viral tests
    • For infections such as hepatitis and HIV
  • Autoimmune tests
    • For conditions like lupus or rheumatoid arthritis
  • Other clotting tests, vitamin and iron levels
    • To rule out other bleeding or anemia causes

Bone Marrow Biopsy

A bone marrow biopsy is not usually required to diagnose ITP. It may be considered if:

  • Platelet counts do not respond to usual treatments
  • There are unusual features in the blood tests or physical exam
  • Another bone marrow problem (like leukemia or aplastic anemia) is suspected

During this procedure, a doctor removes a small sample of bone marrow through a needle, usually from the hip bone, and examines it in a laboratory. In ITP, the bone marrow typically shows normal or increased platelet production.

Medical History and Physical Exam

Your provider will also:

  • Review your medical history, including:
    • Recent infections
    • Medications
    • Family history of bleeding or autoimmune conditions
  • Perform a physical exam looking for:
    • Bruising
    • Petechiae
    • Enlarged spleen or liver
    • Signs of other illnesses

Treatment for ITP in Grand Rapids

Watchful Waiting and Monitoring

If your platelet count is only mildly or moderately low and you are not bleeding, your doctor may recommend:

  • No immediate treatment
  • Regular monitoring with blood tests and check-ins

Some cases of ITP, especially acute ITP in children, resolve on their own without medication.

First-Line Treatments

When platelet counts are very low or there is evidence of bleeding, treatment is started. First-line treatments include:

Corticosteroids

  • Medications such as prednisone are used to suppress the immune system.
  • They reduce the production of antibodies that attack platelets.
  • Can be given as:
    • Tablets taken by mouth
    • Intravenous (IV) injections in the hospital

Intravenous Immunoglobulin (IVIG)

  • A blood product made from concentrated antibodies from healthy donors
  • Thought to “swamp” or block the harmful autoantibodies, protecting platelets
  • Given as an IV infusion over a few hours, usually in a hospital or infusion center
  • Often used when:
    • Rapid increase in platelets is needed
    • Steroids are not enough or not suitable

Second-Line Treatments

If first-line treatments do not work well or if ITP becomes chronic, your Grand Rapids hematologist may recommend:

Splenectomy

  • Surgical removal of the spleen
  • The spleen is a major site where antibody-coated platelets are destroyed
  • Can cure ITP in about 70% of chronic cases
  • Usually considered after other treatments have been tried

Thrombopoietin Receptor Agonists (TPO-RAs)

  • Medications that stimulate the bone marrow to produce more platelets
  • Help keep platelet counts at a safer level over time
  • Commonly used in chronic ITP

Monoclonal Antibodies (e.g., anti-CD20)

  • Target B cells, the immune cells that produce antibodies
  • Help reduce the production of autoantibodies against platelets
  • Given as IV infusions on a schedule determined by your specialist

Your treatment plan will be individualized based on:

  • Your platelet count
  • Presence and severity of bleeding
  • Age and overall health
  • Response to previous treatments
  • Personal preferences and lifestyle

Relapses and Long-Term Outlook

Even after successful treatment, some people with ITP in Grand Rapids may experience a relapse months or years later. Relapses can be triggered by:

  • Viral infections (common in Michigan’s fall and winter seasons)
  • Other illnesses
  • Occasionally, no obvious cause

If relapse occurs, treatment may need to be repeated or adjusted. Many people with ITP, especially those followed by a hematologist at Spectrum Health, Trinity Health Grand Rapids, Metro Health, or Mercy Health, lead full, active lives with proper monitoring and care.

Living With ITP in Grand Rapids, MI

Because Grand Rapids experiences cold, snowy winters and variable spring and fall seasons, viral infections that may trigger or worsen ITP are common. Practical tips include:

  • Stay up to date with vaccinations (as recommended by your doctor)
  • Practice good hand hygiene to reduce infection risk
  • Avoid activities with a high risk of injury or head trauma when platelet counts are very low
  • Discuss any new medications or supplements with your doctor, as some can affect platelets or bleeding

Local resources that may help:

  • Kent County Health Department – information on vaccinations and infectious disease prevention
  • Grand Rapids Public Health programs – community health resources and education
  • Hematology/oncology clinics affiliated with Spectrum Health, Trinity Health Grand Rapids, Metro Health, and Mercy Health

When to Seek Immediate Help

Go to the nearest emergency department in Grand Rapids or call emergency services if you experience:

  • Heavy or uncontrolled bleeding
  • Sudden, severe headache
  • Confusion, trouble speaking, or weakness
  • Blood in vomit, urine, or stool
  • Very heavy menstrual bleeding soaking through pads or tampons rapidly

Key Points About ITP

  • ITP is a rare autoimmune disorder that causes low platelet levels and increases bleeding risk.
  • It is more common in children, usually as acute ITP that often resolves on its own.
  • In adults, ITP is far less common and more likely to be chronic.
  • Chronic ITP has similar symptoms to acute ITP but lasts longer than six months.
  • The exact cause is often unknown (idiopathic), though viral infections and autoimmune conditions can play a role.
  • Diagnosis is based on blood tests, ruling out other causes, and sometimes bone marrow examination.
  • Treatment options in Grand Rapids include observation, corticosteroids, IVIG, splenectomy, thrombopoietin receptor agonists, and monoclonal antibodies.
  • With appropriate care from local specialists and health systems, most people with ITP in Grand Rapids can manage the condition safely.