Como Makes a Mess: A Story about TMA | Cincinnati Children's

Meet Como, a good dog who sometimes makes a mess, and learn about an important complication of bone marrow transplantation: thrombotic microangiopathy, better known as TMA. In patients with TMA, the normally helpful defense protein complement gets over active and can cause damage to important body organs. Cincinnati Children’s is one of the most experienced facilities in the nation in treating TMA and the clinical and research pioneers at Cincinnati Children’s are committed to changing the outcome for children who have it.

Created by the Cincinnati Children’s Media Lab
Animation: Jeff Cimprich and Ren Wilkey
Media lab Direction and additional content expertise: Ken Tegtmeyer, MD
Content Experts: Stella Davies, MBBS, and Jodele Sonata, MD
Voiceover: Emma Perentesis
2D Illustrations: Katie Green
Original Music and Sound Design: Alexander Taylor
Como Concept Design: Sagan Lacy

Como Makes a Mess. A story about trobotic….. tetrobatic…… troboppa …. thrombotic microangiop… oh, let’s just call it TMA.

Como is a very good dog. He lives in our blood vessels and works very hard to help fight infections and repair damage to our blood vessels.

When Como finds bacteria in our bodies, he alerts all other defender cells that fight infection and covers it with complement. Complement is kind of like a sticky gel that helps heal our bodies.

Once Como has coated the bacteria, it’s up to defender cells to respond to his alert and help. His friend Max the Macrophage comes along and clears away the mess. Max and Como work together to keep the body safe.

While Como is a good dog and does important things to keep our bodies safe, sometimes Como gets worried and things don’t go well. Sometimes medicines doctors use to make us better can cause problems by scraping up the blood vessels.

Sometimes bad viruses make things even worse! Poor Como… All of this is making him very nervous.

Como tries to fix the blood vessels by coating the walls with complement, but sometimes when he’s upset, he puts down too much complement and this can block-up the blood vessels.

Red blood cells, Platelets, and blood-clotting factors can all stick to complement. This makes makes it hard for blood cells to flow through our vessels. A blood cell will push it’s way through the blockage and form what’s called a schistocyte, a mangled red cell that doesn’t work well.

Schistocytes are a sign of TMA.

Kids who have TMA feel very ill because blood cant get to where it needs to go. This can cause high blood pressure and low blood counts.

TMA can affect different parts of the body. Blockage of the blood vessels stops oxygen from getting to the lungs, heart and kidneys. Sometimes it can even affect the brain.

Doctors will want to do lots of blood tests and scans to see what is happening. Blood tests help doctors monitor if Como is overactive, or if he’s getting better.

One thing doctors do to make TMA better is try a smaller dose of the medicines that damaged the blood vessels. This can make Como feel a bit better.

But, sometimes this isn’t enough and he goes back to licking a lot.
If lower doses don’t help, we use a special complement blocker medicine. This special medicine helps Como feel better so he stops spreading compliment.

After that, the medicine can blast away all the extra complement.
Once Como feels better and the blood vessels are all unblocked, kids start to feel better.

The medicine lets Como go back to being a good dog who looks out for infections and fights them off.

Como is a very good dog who really just wants to help.
Good dog, Como!


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