DLC (Differential Leukocyte Count) Study Guide

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// ─── SECTION 1: Introduction ──────────────────────────────────────────────────
children.push(h1("1. What Is the DLC?"));
children.push(para("The Differential Leukocyte Count (DLC) quantifies the relative (%) and absolute (cells/µL) concentration of each leukocyte type in peripheral blood. It is performed as part of the automated CBC and reviewed by a skilled technologist when abnormal flags appear."));
children.push(note("Always use the absolute count (WBC total × cell %), not just the percentage, to determine a true abnormality. A raised % of one cell type can simply reflect a reduction in another."));
children.push(para("Normal total WBC in adults: 4,000–7,000 cells/µL (broad reference: ~4,500–11,000/µL). Approximately two-thirds are neutrophils and just under one-third are lymphocytes."));

// ─── SECTION 2: Normal Reference Ranges ──────────────────────────────────────
children.push(h1("2. Normal DLC Reference Ranges (Adults)"));
children.push(makeTable(
  ["Cell Type", "% of WBC", "Absolute Count (×10³/µL)", "Key Notes"],
  [
    ["Neutrophils (segs + bands)", "50–70%", "1.8–7.0", "Bands normally <5%"],
    ["Lymphocytes", "20–40%", "1.0–4.8", "Dominant cell type in children <4 yrs"],
    ["Monocytes", "2–10%", "0.2–1.0", "Largest circulating WBC"],
    ["Eosinophils", "1–4%", "0.04–0.4", "Elevated in allergies/parasites"],
    ["Basophils", "0–1%", "0.01–0.1", "Rarest; carrier of histamine"],
  ],
  BLUE_HEADER
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children.push(para("Reference ranges may vary slightly by laboratory, age, and sex.", { color: "666666", italics: true, size: 18 }));

// ─── SECTION 3: NEUTROPHILS ───────────────────────────────────────────────────
children.push(h1("3. Neutrophils"));

children.push(h2("Normal Morphology"));
children.push(bullet("Segmented nucleus with 3–5 lobes, pale pink cytoplasm with fine pink-purple granules"));
children.push(bullet("Bands: horseshoe/U-shaped unsegmented nucleus, normally <5% of differential"));

children.push(h2("Neutrophilia (Neutrophilic Leukocytosis)"));
children.push(para("Definition: Absolute neutrophils >7.0 ×10³/µL in adults."));

children.push(h3("Mechanisms"));
children.push(bullet("Demargination/pseudoneutrophilia", "Epinephrine, exercise, stress"));
children.push(bullet("Increased marrow output", "Cortisol/steroids, severe infection"));
children.push(bullet("Decreased egress from blood", "Corticosteroids block tissue migration"));

children.push(spacer(80));
children.push(h3("Causes of Neutrophilia"));
children.push(makeTable(
  ["Category", "Examples"],
  [
    ["Infections", "Bacterial (most common), fungal, some viral"],
    ["Inflammation", "Trauma, surgery, burns, myocardial infarction"],
    ["Drugs", "Corticosteroids, G-CSF, lithium"],
    ["Physiologic", "Exercise, stress, pregnancy, neonatal period"],
    ["Neoplastic", "CML, myeloproliferative disorders"],
    ["Metabolic", "Uremia, diabetic ketoacidosis, gout"],
    ["Other", "Asplenia, acute hemorrhage, hemolysis"],
  ],
  BLUE_HEADER
));
children.push(note("Exceptions to neutrophilia in bacterial infection: Tuberculosis, brucellosis, pertussis (lymphocyte-dominant), Listeria (monocyte-dominant)."));

children.push(h3("Left Shift"));
children.push(para("Increased immature neutrophils (bands, metamyelocytes, myelocytes) released from marrow. Reactive left shift rarely includes promyelocytes or blasts. Accompanies severe infections and sepsis."));

children.push(h3("Toxic Changes in Neutrophils"));
children.push(makeTable(
  ["Change", "Description", "Clinical Setting"],
  [
    ["Toxic granulation", "Dark azurophilic (primary) granules in cytoplasm", "Severe infections, toxic conditions, reactive states"],
    ["Döhle bodies", "Pale-blue oval cytoplasmic inclusions (ribosome remnants)", "Infections and other toxic conditions"],
    ["Cytoplasmic vacuoles", "Empty vacuoles in cytoplasm", "Active phagocytosis; infection"],
  ],
  BLUE_HEADER
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children.push(h2("Neutropenia"));
children.push(para("Definition: Absolute neutrophils <1.8 ×10³/µL (adults)."));
children.push(h3("Severity Grading"));
children.push(bullet("Mild: 1.0–1.8 ×10³/µL"));
children.push(bullet("Moderate: 0.5–1.0 ×10³/µL"));
children.push(bullet("Severe (agranulocytosis): <0.5 ×10³/µL — high risk of life-threatening infection"));

children.push(spacer(80));
children.push(h3("Key Causes of Neutropenia"));
children.push(makeTable(
  ["Category", "Examples"],
  [
    ["Drugs (most common)", "Chemotherapy, chloramphenicol, sulfonamides, phenothiazines, antithyroids, anticonvulsants"],
    ["Radiation", "Dose-dependent marrow damage"],
    ["Toxins", "Alcohol, benzene compounds"],
    ["Immune-mediated", "SLE, RA/Felty syndrome, AIDS"],
    ["Congenital", "Kostmann syndrome, cyclic neutropenia (ELA2 mutations, ~21-day cycle), Chédiak-Higashi"],
    ["Hematologic", "Megaloblastic anemia, myelodysplasia, aplastic anemia, marrow infiltration"],
    ["Infectious", "Overwhelming bacterial infection; viral-mediated suppression (measles, rubella)"],
    ["Other", "Starvation, hypersplenism"],
  ],
  RED_HDR
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children.push(note("Toxic granulation, left shift, and Döhle bodies are seen with infection-related neutropenia but NOT in neutropenia of pregnancy-induced hypertension (PIH) — a useful distinguishing point."));

children.push(h2("Morphological Anomalies of Neutrophils"));
children.push(makeTable(
  ["Anomaly", "Description", "Significance"],
  [
    ["Pelger-Huët", "Bilobed / 'pince-nez' nucleus", "Inherited (benign) or acquired in MDS"],
    ["Hypersegmentation", "≥5 lobes; ≥5% of neutrophils have ≥5 lobes", "Megaloblastic anemia (B12/folate deficiency)"],
    ["Alder-Reilly", "Prominent azurophilic granulation (not infection-related)", "Mucopolysaccharidoses"],
    ["May-Hegglin", "Döhle-like inclusions + giant platelets", "Rare autosomal-dominant anomaly"],
    ["Chédiak-Higashi", "Giant fused granules (abnormal lysosomes) in all leukocytes", "Autosomal-recessive; recurrent pyogenic infections, partial oculocutaneous albinism"],
  ],
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// ─── SECTION 4: LYMPHOCYTES ───────────────────────────────────────────────────
children.push(h1("4. Lymphocytes"));

children.push(h2("Lymphocytosis"));
children.push(para("Definition: Absolute lymphocytes >4.8 ×10³/µL (adults). Physiologically normal in children."));
children.push(makeTable(
  ["Category", "Examples"],
  [
    ["Acute viral infections (most common)", "EBV (mononucleosis), CMV, hepatitis, rubella, pertussis"],
    ["Chronic infections", "Tuberculosis, brucellosis, toxoplasmosis"],
    ["Autoimmune", "Early RA and other autoimmune disorders"],
    ["Neoplastic", "CLL, ALL, lymphomas"],
  ],
  BLUE_HEADER
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children.push(note("Reactive (atypical) lymphocytes: Larger cells with abundant blue-gray cytoplasm and eccentric kidney-shaped nucleus. Classically seen in EBV mononucleosis — represent T-cell activation."));

children.push(h2("Lymphopenia (Lymphocytopenia)"));
children.push(para("Definition: Absolute lymphocytes <1.0 ×10³/µL."));
children.push(makeTable(
  ["Category", "Examples"],
  [
    ["Immunodeficiency", "HIV/AIDS, DiGeorge syndrome, SCID"],
    ["Adrenocortical excess", "Cushing's syndrome, high-dose corticosteroids"],
    ["Cytotoxic therapy", "Chemotherapy, radiation (lymphocytes are most radiosensitive WBCs)"],
    ["Advanced malignancy", "Lymphomas, advanced carcinomas"],
    ["Other", "Impaired intestinal lymphatic drainage, anorexia nervosa"],
  ],
  RED_HDR
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// ─── SECTION 5: MONOCYTES ─────────────────────────────────────────────────────
children.push(h1("5. Monocytes"));

children.push(h2("Monocytosis"));
children.push(para("Definition: Absolute monocytes >1.0 ×10³/µL."));
children.push(makeTable(
  ["Category", "Examples"],
  [
    ["Infections", "TB, brucellosis, subacute bacterial endocarditis, Listeria, protozoal infections"],
    ["Hematologic malignancy", "AML-M5 (acute monocytic leukemia), AML-M4, MDS"],
    ["Inflammatory / autoimmune", "SLE, IBD, sarcoidosis"],
    ["Recovery phase", "Post-chemotherapy or radiation (monocytes recover before neutrophils)"],
    ["GI disorders", "Sprue, ulcerative colitis"],
    ["Drug reactions", "Various drugs"],
  ],
  BLUE_HEADER
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children.push(note("Listeria monocytogenes infection produces a predominantly monocytic WBC response (especially in neonates)."));

children.push(h2("Monocytopenia"));
children.push(para("Causes: Onset of steroid therapy; hairy cell leukemia (characteristic finding). Isolated monocytopenia is not usually considered pathologic."));

// ─── SECTION 6: EOSINOPHILS ──────────────────────────────────────────────────
children.push(h1("6. Eosinophils"));

children.push(h2("Eosinophilia"));
children.push(para("Definition: Absolute eosinophils >0.4 ×10³/µL (>4% on differential)."));
children.push(h3("Severity Grading"));
children.push(bullet("Mild: 0.4–1.5 ×10³/µL"));
children.push(bullet("Moderate: 1.5–5.0 ×10³/µL"));
children.push(bullet("Severe / Hypereosinophilia: >5.0 ×10³/µL — risk of end-organ damage"));

children.push(spacer(80));
children.push(makeTable(
  ["Category", "Examples"],
  [
    ["Allergic (most common in developed countries)", "Asthma, hay fever, urticaria, atopic dermatitis, angioedema"],
    ["Parasitic (most common globally)", "Tissue-invasive helminths (Ascaris, hookworm, Toxocara, Strongyloides)"],
    ["Neoplastic", "CML, eosinophilic leukemia, Hodgkin lymphoma, solid tumor metastases"],
    ["Cutaneous", "Eczema, psoriasis, pemphigus"],
    ["Pulmonary", "Löffler syndrome, eosinophilic pneumonia"],
    ["Drug reactions", "NSAIDs, antibiotics"],
    ["Other", "Addison disease, Lyme disease, rheumatic fever, post-irradiation"],
  ],
  BLUE_HEADER
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children.push(note("In synovial fluid: eosinophilia >2% reported in Lyme disease, RA, rheumatic fever, metastatic carcinoma, and allergic reactions to contrast dye."));

children.push(h2("Eosinopenia"));
children.push(para("Causes: Acute physical stress, acute inflammatory states, Cushing's syndrome, corticosteroid therapy. Often difficult to detect given the normally very low baseline count."));

// ─── SECTION 7: BASOPHILS ────────────────────────────────────────────────────
children.push(h1("7. Basophils"));

children.push(h2("Basophilia"));
children.push(para("Definition: Absolute basophils >0.1 ×10³/µL."));
children.push(makeTable(
  ["Category", "Examples"],
  [
    ["Hematologic (most specific)", "CML (very characteristic), polycythemia vera, myeloid metaplasia"],
    ["Inflammatory / allergic", "Hypersensitivity reactions, chronic sinusitis"],
    ["Endocrine", "Hypothyroidism"],
    ["Other", "Chronic hemolytic anemia, splenectomy, ionizing radiation"],
  ],
  BLUE_HEADER
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children.push(note("Persistent basophilia combined with neutrophilia and eosinophilia strongly suggests CML — check for BCR-ABL fusion gene / Philadelphia chromosome."));

children.push(h2("Basopenia"));
children.push(para("Causes: Sustained glucocorticoid treatment, acute infection or stress, hyperthyroidism. Difficult to detect given normally very low baseline count."));

// ─── SECTION 8: Quick Pattern Recognition ─────────────────────────────────────
children.push(h1("8. Quick Pattern Recognition"));
children.push(makeTable(
  ["DLC Pattern", "First Diagnosis to Suspect"],
  [
    ["Neutrophilia + left shift + toxic changes", "Bacterial infection / sepsis"],
    ["Neutrophilia alone (no toxic changes)", "Physiologic stress, corticosteroids"],
    ["Neutropenia + no toxic changes", "Drug effect, pregnancy-induced hypertension, immune-mediated"],
    ["Lymphocytosis + atypical lymphocytes", "EBV infectious mononucleosis"],
    ["Lymphocytosis + mature small lymphocytes", "CLL (chronic lymphocytic leukemia)"],
    ["Eosinophilia mild-moderate", "Allergy, atopic disease"],
    ["Eosinophilia marked", "Tissue-invasive parasites"],
    ["Basophilia", "CML (until proven otherwise)"],
    ["Monocytosis", "TB, chronic infection, AML-M5"],
    ["Lymphopenia", "HIV/AIDS, corticosteroids, radiation"],
    ["Pancytopenia", "Aplastic anemia, marrow infiltration, megaloblastic anemia"],
    ["Neutrophilia + basophilia + eosinophilia", "CML (leukemoid reaction if BCR-ABL negative)"],
  ],
  GREEN_HDR
));

// ─── SECTION 9: DLC in Specific Diseases ─────────────────────────────────────
children.push(h1("9. DLC Patterns in Specific Diseases"));
children.push(makeTable(
  ["Disease", "Classic DLC Pattern"],
  [
    ["Bacterial sepsis", "Neutrophilia, left shift, toxic granulation, Döhle bodies, vacuoles"],
    ["Viral infection (EBV/mono)", "Lymphocytosis with atypical (reactive) lymphocytes"],
    ["CML", "Neutrophilia + basophilia + eosinophilia; all myeloid stages; BCR-ABL positive"],
    ["CLL", "Lymphocytosis of mature-looking small lymphocytes; smear cells on film"],
    ["Pertussis (whooping cough)", "Lymphocytosis (unusually, for a bacterial infection)"],
    ["Tuberculosis", "Lymphocytosis or monocytosis; neutropenia possible"],
    ["Parasitic infection", "Eosinophilia (especially tissue-invasive helminths)"],
    ["Allergic reaction", "Eosinophilia ± basophilia"],
    ["HIV/AIDS", "Lymphopenia (CD4+ T-cell depletion), neutropenia"],
    ["Felty syndrome", "Neutropenia + RA + splenomegaly"],
    ["B12/folate deficiency", "Hypersegmented neutrophils, pancytopenia; macrocytic anemia"],
    ["Addison's disease", "Eosinophilia, lymphocytosis, neutropenia"],
    ["Cushing's syndrome", "Neutrophilia, lymphopenia, eosinopenia"],
    ["Listeria infection (neonates)", "Monocytosis (predominant response)"],
  ],
  YELLOW_HDR
));

// ─── SECTION 10: Key Formulas ─────────────────────────────────────────────────
children.push(h1("10. Key Formulas"));
children.push(makeTable(
  ["Formula", "Expression"],
  [
    ["Absolute cell count", "Total WBC × (% of cell type / 100)"],
    ["Corrected WBC (for nRBCs)", "WBC × 100 ÷ (100 + number of nRBCs per 100 WBCs)"],
  ],
  BLUE_HEADER
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    line: { color: "none" },
    rectRadius: 0.05,
  });
  slide.addText(text, {
    x, y, w: 1.5, h: 0.3,
    fontSize: 10, bold: true, color: textColor,
    fontFace: "Calibri", align: "center", valign: "middle", margin: 0,
  });
}

// Table builder
function addTable(slide, headers, rows, x, y, w, h, headerColor = C.navy) {
  const colW = w / headers.length;
  const rowH = Math.min(0.32, (h - 0.36) / rows.length);

  // Header row
  headers.forEach((hdr, i) => {
    addRect(slide, x + i * colW, y, colW, 0.34, headerColor);
    slide.addText(hdr, {
      x: x + i * colW + 0.05, y: y + 0.04, w: colW - 0.1, h: 0.26,
      fontSize: 11, bold: true, color: C.white, fontFace: "Calibri",
      valign: "middle", margin: 0,
    });
  });

  // Data rows
  rows.forEach((row, ri) => {
    const rowBg = ri % 2 === 0 ? C.white : C.blueLight;
    row.forEach((cell, ci) => {
      addRect(slide, x + ci * colW, y + 0.34 + ri * rowH, colW, rowH, rowBg);
      slide.addText(cell, {
        x: x + ci * colW + 0.06, y: y + 0.34 + ri * rowH,
        w: colW - 0.12, h: rowH,
        fontSize: 10, color: C.darkgrey, fontFace: "Calibri",
        valign: "middle", margin: 0,
      });
    });
  });
}

// Callout note box
function noteBox(slide, text, x, y, w, color = C.blue) {
  addRect(slide, x, y, 0.06, 0.38, color);
  addRect(slide, x + 0.06, y, w - 0.06, 0.38, C.blueLight);
  slide.addText(text, {
    x: x + 0.12, y, w: w - 0.18, h: 0.38,
    fontSize: 11, color: C.navy, fontFace: "Calibri",
    valign: "middle", italic: true, margin: 0,
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.navy);
  addRect(s, 0, 3.9, 10, 1.7, C.blue);
  addRect(s, 0, 3.85, 10, 0.08, C.teal);

  s.addText("DLC Study Guide", {
    x: 0.5, y: 0.7, w: 9, h: 1.4,
    fontSize: 52, bold: true, color: C.white,
    fontFace: "Calibri", align: "center", valign: "middle",
  });
  s.addText("Differential Leukocyte Count", {
    x: 0.5, y: 2.1, w: 9, h: 0.55,
    fontSize: 26, color: C.blueLight, fontFace: "Calibri",
    align: "center", valign: "middle",
  });
  s.addText("Normal vs. Abnormal Patterns", {
    x: 0.5, y: 2.65, w: 9, h: 0.45,
    fontSize: 22, color: C.tealLight, fontFace: "Calibri",
    align: "center", valign: "middle", italic: true,
  });
  s.addText("Sources: Henry's Clinical Diagnosis & Management (23e)  |  Goldman-Cecil Medicine  |  Textbook of Family Medicine (9e)  |  Tietz Textbook of Laboratory Medicine (7e)", {
    x: 0.4, y: 4.05, w: 9.2, h: 0.5,
    fontSize: 10, color: C.blueHdr, fontFace: "Calibri",
    align: "center", valign: "middle", italic: true,
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — What Is the DLC?
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "What Is the DLC?");

  s.addText([
    { text: "The DLC quantifies the ", options: {} },
    { text: "relative (%) and absolute (cells/µL)", options: { bold: true, color: C.blue } },
    { text: " concentration of each leukocyte type in peripheral blood.", options: {} },
  ], { x: 0.45, y: 1.0, w: 9.1, h: 0.5, fontSize: 15, fontFace: "Calibri", color: C.darkgrey, valign: "top", margin: 0 });

  noteBox(s, "Always use the ABSOLUTE count (WBC × cell %), not just percentage, to judge a true abnormality.", 0.45, 1.6, 9.1);

  s.addText("Normal Total WBC (Adults):", {
    x: 0.45, y: 2.12, w: 3.5, h: 0.35,
    fontSize: 13, bold: true, color: C.navy, fontFace: "Calibri", valign: "middle", margin: 0,
  });
  s.addText("4,000 – 7,000 cells/µL", {
    x: 3.85, y: 2.12, w: 3, h: 0.35,
    fontSize: 13, color: C.darkgrey, fontFace: "Calibri", valign: "middle", margin: 0,
  });
  s.addText("(broader reference: ~4,500 – 11,000 / µL)", {
    x: 6.7, y: 2.12, w: 3, h: 0.35,
    fontSize: 11, italic: true, color: C.grey, fontFace: "Calibri", valign: "middle", margin: 0,
  });

  addTable(s,
    ["Cell Type", "% of WBC", "Absolute Count (×10³/µL)", "Key Notes"],
    [
      ["Neutrophils (segs + bands)", "50–70%", "1.8–7.0", "Bands <5%; dominant in adults"],
      ["Lymphocytes",                "20–40%", "1.0–4.8", "Dominant in children <4 yrs"],
      ["Monocytes",                  "2–10%",  "0.2–1.0", "Largest circulating WBC"],
      ["Eosinophils",                "1–4%",   "0.04–0.4","Elevated in allergies / parasites"],
      ["Basophils",                  "0–1%",   "0.01–0.1","Rarest; carrier of histamine"],
    ],
    0.45, 2.55, 9.1, 2.75, C.navy
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Neutrophils: Normal & Neutrophilia
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "Neutrophils — Neutrophilia");
  badge(s, "NEUTROPHIL", 8.1, 0.25, C.blue);

  // Normal morphology box
  addRect(s, 0.45, 1.0, 4.3, 0.28, C.navy);
  s.addText("Normal Morphology", { x: 0.5, y: 1.0, w: 4.2, h: 0.28, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  s.addText([
    { text: "• ", options: {} }, { text: "3–5 lobed", options: { bold: true } }, { text: " segmented nucleus; fine pink-purple granules\n", options: {} },
    { text: "• Bands: ", options: { bold: true } }, { text: "horseshoe nucleus, normally <5%", options: {} },
  ], { x: 0.5, y: 1.3, w: 4.2, h: 0.55, fontSize: 12, fontFace: "Calibri", color: C.darkgrey, valign: "top", margin: 0 });

  // Definition
  addRect(s, 5.0, 1.0, 4.55, 0.28, C.blue);
  s.addText("Neutrophilia  >7.0 ×10³/µL", { x: 5.05, y: 1.0, w: 4.45, h: 0.28, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  s.addText([
    { text: "Mechanisms:\n", options: { bold: true, color: C.navy } },
    { text: "• Demargination", options: { bold: true } }, { text: " (exercise, epinephrine, stress)\n", options: {} },
    { text: "• Increased marrow output", options: { bold: true } }, { text: " (infection, steroids)\n", options: {} },
    { text: "• Decreased egress", options: { bold: true } }, { text: " (corticosteroids block tissue migration)", options: {} },
  ], { x: 5.05, y: 1.3, w: 4.45, h: 0.72, fontSize: 11.5, fontFace: "Calibri", color: C.darkgrey, valign: "top", margin: 0 });

  addTable(s,
    ["Category", "Key Examples"],
    [
      ["Infections",  "Bacterial (most common), fungal, some viral"],
      ["Inflammation","Trauma, surgery, burns, myocardial infarction"],
      ["Drugs",       "Corticosteroids, G-CSF, lithium"],
      ["Physiologic", "Exercise, stress, pregnancy, neonatal period"],
      ["Neoplastic",  "CML, myeloproliferative disorders"],
      ["Metabolic",   "Uremia, DKA, gout"],
    ],
    0.45, 2.0, 9.1, 2.4, C.blue
  );

  noteBox(s, "Exceptions — NOT neutrophilic: TB, brucellosis, pertussis (lymphocytes dominant); Listeria (monocytes dominant).", 0.45, 4.52, 9.1, C.teal);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Left Shift + Toxic Changes
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "Neutrophils — Left Shift & Toxic Changes");

  // Left shift
  addRect(s, 0.45, 1.0, 4.6, 0.3, C.teal);
  s.addText("Left Shift", { x: 0.5, y: 1.0, w: 4.5, h: 0.3, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  s.addText([
    { text: "Release of immature neutrophils from marrow:\n", options: { bold: true } },
    { text: "Bands → Metamyelocytes → Myelocytes\n(Promyelocytes/blasts suggest leukemia, not reactive)", options: {} },
  ], { x: 0.5, y: 1.35, w: 4.5, h: 0.75, fontSize: 12, fontFace: "Calibri", color: C.darkgrey, valign: "top", margin: 0 });

  // Toxic changes table
  addRect(s, 5.2, 1.0, 4.35, 0.3, C.red);
  s.addText("Toxic Changes in Neutrophils", { x: 5.25, y: 1.0, w: 4.25, h: 0.3, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  addTable(s,
    ["Change", "Description"],
    [
      ["Toxic granulation", "Dark azurophilic (primary) granules — severe infection/toxic states"],
      ["Döhle bodies",      "Pale-blue oval cytoplasmic inclusions (ribosome remnants) — infection"],
      ["Cytoplasmic vacuoles","Empty vacuoles — active phagocytosis"],
    ],
    5.2, 1.35, 4.35, 1.5, C.red
  );

  // Morphological anomalies table
  addRect(s, 0.45, 2.2, 9.1, 0.3, C.amber);
  s.addText("Morphological Anomalies of Neutrophils", { x: 0.5, y: 2.2, w: 9, h: 0.3, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  addTable(s,
    ["Anomaly", "Description", "Significance"],
    [
      ["Pelger-Huët",      "Bilobed / pince-nez nucleus",               "Inherited (benign) or acquired in MDS"],
      ["Hypersegmentation","≥5 nuclear lobes in ≥5% of neutrophils",    "Megaloblastic anemia (B12/folate deficiency)"],
      ["Alder-Reilly",     "Prominent azurophilic granulation",          "Mucopolysaccharidoses; NOT infection"],
      ["May-Hegglin",      "Döhle-like inclusions + giant platelets",    "Rare autosomal-dominant anomaly"],
      ["Chédiak-Higashi",  "Giant fused lysosomes in all leukocytes",    "AR disorder; recurrent pyogenic infections, partial albinism"],
    ],
    0.45, 2.55, 9.1, 2.7, C.amber
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — Neutropenia
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "Neutropenia");
  badge(s, "NEUTROPENIA", 7.8, 0.25, C.red);

  // Severity grading
  addRect(s, 0.45, 1.0, 2.8, 0.28, C.red);
  s.addText("Severity Grading", { x: 0.5, y: 1.0, w: 2.7, h: 0.28, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  const grades = [
    { label: "Mild", range: "1.0–1.8 ×10³/µL", color: C.amberLight, txt: C.amber },
    { label: "Moderate", range: "0.5–1.0 ×10³/µL", color: C.redLight, txt: C.red },
    { label: "Severe / Agranulocytosis", range: "<0.5 ×10³/µL  ⚠ High infection risk", color: C.red, txt: C.white },
  ];
  grades.forEach((g, i) => {
    addRect(s, 0.45, 1.32 + i * 0.34, 2.8, 0.3, g.color);
    s.addText(`${g.label}: ${g.range}`, {
      x: 0.55, y: 1.32 + i * 0.34, w: 2.65, h: 0.3,
      fontSize: 10.5, color: g.txt, fontFace: "Calibri",
      bold: g.label === "Severe / Agranulocytosis", valign: "middle", margin: 0,
    });
  });

  addTable(s,
    ["Category", "Examples"],
    [
      ["Drugs (most common)", "Chemo, chloramphenicol, sulfonamides, phenothiazines, antithyroids, anticonvulsants"],
      ["Radiation",           "Dose-dependent marrow damage; lymphocytes most sensitive"],
      ["Toxins",              "Alcohol, benzene compounds"],
      ["Immune-mediated",     "SLE, RA / Felty syndrome, AIDS"],
      ["Congenital",          "Kostmann, cyclic neutropenia (ELA2 mutations, ~21-day cycle), Chédiak-Higashi"],
      ["Hematologic",         "Megaloblastic anemia, MDS, aplastic anemia, marrow infiltration"],
      ["Infectious",          "Overwhelming bacterial infection; measles, rubella (viral suppression)"],
      ["Other",               "Starvation, hypersplenism"],
    ],
    3.35, 1.0, 6.2, 3.3, C.red
  );

  noteBox(s, "Toxic granulation, left shift, and Döhle bodies are seen with infection-related neutropenia — but NOT in PIH (pregnancy-induced hypertension) neutropenia. Useful distinguishing point.", 0.45, 4.52, 9.1, C.red);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Lymphocytes
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "Lymphocytes");
  badge(s, "LYMPHOCYTES", 7.8, 0.25, C.teal);

  // Lymphocytosis
  addRect(s, 0.45, 1.0, 4.55, 0.3, C.teal);
  s.addText("Lymphocytosis  >4.8 ×10³/µL", { x: 0.5, y: 1.0, w: 4.45, h: 0.3, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  addTable(s,
    ["Category", "Examples"],
    [
      ["Acute viral (most common)", "EBV (mono), CMV, hepatitis, rubella, pertussis"],
      ["Chronic infections",        "TB, brucellosis, toxoplasmosis"],
      ["Autoimmune",                "Early RA, other autoimmune disorders"],
      ["Neoplastic",                "CLL, ALL, lymphomas"],
    ],
    0.45, 1.34, 4.55, 2.0, C.teal
  );

  noteBox(s, "Reactive (atypical) lymphocytes: Large, blue-gray cytoplasm, eccentric kidney-shaped nucleus — classically seen in EBV mononucleosis (T-cell activation).", 0.45, 3.45, 4.55, C.teal);

  // Lymphopenia
  addRect(s, 5.1, 1.0, 4.45, 0.3, C.red);
  s.addText("Lymphopenia  <1.0 ×10³/µL", { x: 5.15, y: 1.0, w: 4.35, h: 0.3, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  addTable(s,
    ["Category", "Examples"],
    [
      ["Immunodeficiency",     "HIV/AIDS, DiGeorge syndrome, SCID"],
      ["Adrenocortical excess","Cushing's syndrome, high-dose corticosteroids"],
      ["Cytotoxic therapy",   "Chemo, radiation (lymphocytes most radiosensitive)"],
      ["Advanced malignancy", "Lymphomas, advanced carcinomas"],
      ["Other",               "Impaired intestinal lymphatics, anorexia nervosa"],
    ],
    5.1, 1.34, 4.45, 2.0, C.red
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Monocytes & Eosinophils
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "Monocytes & Eosinophils");

  // Monocytes left
  addRect(s, 0.45, 1.0, 4.55, 0.3, C.navy);
  s.addText("Monocytosis  >1.0 ×10³/µL", { x: 0.5, y: 1.0, w: 4.45, h: 0.3, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  addTable(s,
    ["Category", "Examples"],
    [
      ["Infections",       "TB, brucellosis, SBE, Listeria, protozoal"],
      ["Hematologic",      "AML-M5, AML-M4, MDS"],
      ["Inflammatory",     "SLE, IBD, sarcoidosis"],
      ["Recovery phase",   "Post-chemo/radiation (monocytes recover before neutrophils)"],
      ["Other",            "Sprue, ulcerative colitis, drug reactions"],
    ],
    0.45, 1.34, 4.55, 1.9, C.navy
  );

  addRect(s, 0.45, 3.3, 4.55, 0.28, C.grey);
  s.addText("Monocytopenia", { x: 0.5, y: 3.3, w: 4.45, h: 0.28, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  s.addText("Steroid therapy (onset); hairy cell leukemia (characteristic). Isolated monocytopenia not usually pathologic.", {
    x: 0.5, y: 3.62, w: 4.45, h: 0.4, fontSize: 11, fontFace: "Calibri", color: C.darkgrey, valign: "top", margin: 0,
  });
  noteBox(s, "Listeria infection → monocytic response (especially in neonates).", 0.45, 4.1, 4.55, C.navy);

  // Eosinophils right
  addRect(s, 5.1, 1.0, 4.45, 0.3, C.green);
  s.addText("Eosinophilia  >0.4 ×10³/µL", { x: 5.15, y: 1.0, w: 4.35, h: 0.3, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  // Severity
  const eGrades = [
    ["Mild",   "0.4–1.5 ×10³/µL", C.greenLight, C.green],
    ["Moderate","1.5–5.0 ×10³/µL", C.green,     C.white],
    ["Severe","  >5.0 ×10³/µL",    C.navy,      C.white],
  ];
  eGrades.forEach(([label, range, bg, tc], i) => {
    addRect(s, 5.1, 1.34 + i * 0.28, 4.45, 0.26, bg);
    s.addText(`${label}: ${range}`, { x: 5.18, y: 1.34 + i * 0.28, w: 4.3, h: 0.26, fontSize: 10, color: tc, fontFace: "Calibri", bold: true, valign: "middle", margin: 0 });
  });

  addTable(s,
    ["Category", "Examples"],
    [
      ["Allergic",   "Asthma, hay fever, urticaria, atopic dermatitis"],
      ["Parasitic",  "Tissue-invasive helminths (Ascaris, hookworm, Toxocara)"],
      ["Neoplastic", "CML, eosinophilic leukemia, Hodgkin lymphoma"],
      ["Other",      "Addison disease, Löffler syndrome, drug reactions"],
    ],
    5.1, 2.2, 4.45, 1.8, C.green
  );

  addRect(s, 5.1, 4.08, 4.45, 0.28, C.grey);
  s.addText("Eosinopenia: Acute stress, Cushing's, corticosteroids", { x: 5.15, y: 4.08, w: 4.35, h: 0.28, fontSize: 10, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Basophils
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "Basophils");
  badge(s, "BASOPHILS", 8.2, 0.25, C.amber);

  addRect(s, 0.45, 1.0, 9.1, 0.3, C.amber);
  s.addText("Basophilia  >0.1 ×10³/µL", { x: 0.5, y: 1.0, w: 9.0, h: 0.3, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });

  addTable(s,
    ["Category", "Examples"],
    [
      ["Hematologic (most specific)", "CML (very characteristic), polycythemia vera, myeloid metaplasia"],
      ["Inflammatory / allergic",     "Hypersensitivity reactions, chronic sinusitis"],
      ["Endocrine",                   "Hypothyroidism"],
      ["Other",                       "Chronic hemolytic anemia, splenectomy, ionizing radiation"],
    ],
    0.45, 1.34, 9.1, 1.8, C.amber
  );

  noteBox(s, "Persistent basophilia + neutrophilia + eosinophilia = strongly suspect CML. Check for BCR-ABL fusion gene / Philadelphia chromosome.", 0.45, 3.2, 9.1, C.amber);

  addRect(s, 0.45, 3.7, 9.1, 0.3, C.grey);
  s.addText("Basopenia: Sustained glucocorticoids | Acute infection or stress | Hyperthyroidism", {
    x: 0.5, y: 3.7, w: 9.0, h: 0.3, fontSize: 12, bold: true, color: C.white,
    fontFace: "Calibri", valign: "middle", margin: 0,
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — Quick Pattern Recognition
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "Quick Pattern Recognition");

  addTable(s,
    ["DLC Pattern", "First Diagnosis to Suspect"],
    [
      ["Neutrophilia + left shift + toxic changes",    "Bacterial infection / sepsis"],
      ["Neutrophilia alone (no toxic changes)",        "Physiologic stress, corticosteroids"],
      ["Neutropenia + no toxic changes",               "Drug effect, PIH, immune-mediated"],
      ["Lymphocytosis + atypical lymphocytes",         "EBV infectious mononucleosis"],
      ["Lymphocytosis + mature small lymphocytes",     "CLL (chronic lymphocytic leukemia)"],
      ["Eosinophilia mild-moderate",                   "Allergy / atopic disease"],
      ["Eosinophilia marked (>5.0 ×10³/µL)",          "Tissue-invasive parasites"],
      ["Basophilia",                                   "CML (until proven otherwise)"],
      ["Monocytosis",                                  "TB, chronic infection, AML-M5"],
      ["Lymphopenia",                                  "HIV/AIDS, corticosteroids, radiation"],
      ["Pancytopenia",                                 "Aplastic anemia, marrow infiltration, megaloblastic anemia"],
      ["Neutrophilia + basophilia + eosinophilia",     "CML (or leukemoid reaction if BCR-ABL negative)"],
    ],
    0.45, 1.0, 9.1, 4.5, C.green
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — DLC in Specific Diseases
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offwhite);
  section_header(s, "DLC Patterns in Specific Diseases");

  addTable(s,
    ["Disease", "Classic DLC Pattern"],
    [
      ["Bacterial sepsis",          "Neutrophilia + left shift + toxic granulation + Döhle bodies + vacuoles"],
      ["Viral infection (EBV/mono)","Lymphocytosis with atypical (reactive) lymphocytes"],
      ["CML",                       "Neutrophilia + basophilia + eosinophilia; all myeloid stages; BCR-ABL+"],
      ["CLL",                       "Lymphocytosis of mature small lymphocytes; smear (smudge) cells"],
      ["Pertussis",                 "Lymphocytosis (unusual for a bacterial cause)"],
      ["Tuberculosis",              "Lymphocytosis or monocytosis; possible neutropenia"],
      ["Parasitic infection",       "Eosinophilia (tissue-invasive helminths especially)"],
      ["HIV/AIDS",                  "Lymphopenia (CD4+ depletion) + neutropenia"],
      ["Felty syndrome",            "Neutropenia + RA + splenomegaly"],
      ["B12 / folate deficiency",   "Hypersegmented neutrophils; pancytopenia; macrocytic anemia"],
      ["Cushing's syndrome",        "Neutrophilia + lymphopenia + eosinopenia"],
      ["Addison's disease",         "Eosinophilia + lymphocytosis + neutropenia"],
    ],
    0.45, 1.0, 9.1, 4.5, C.amber
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Key Formulas + Sources
// ════════════════════════════════════════════════════════════════════════════
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  const sources = [
    "Henry's Clinical Diagnosis and Management by Laboratory Methods, 23rd edition",
    "Goldman-Cecil Medicine (International Edition)",
    "Textbook of Family Medicine, 9th edition",
    "Tietz Textbook of Laboratory Medicine, 7th edition",
    "Quick Compendium of Clinical Pathology, 5th edition",
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — End slide
// ════════════════════════════════════════════════════════════════════════════
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  s.addText("Thank You", {
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    fontSize: 54, bold: true, color: C.white,
    fontFace: "Calibri", align: "center", valign: "middle",
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  s.addText("DLC Study Guide — Differential Leukocyte Count: Normal vs. Abnormal Patterns", {
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  s.addText("For educational purposes only  |  Always verify clinical decisions against current guidelines", {
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// ── Write file ────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/dlc-study-guide/DLC_Study_Guide.pptx" })
  .then(() => console.log("Done: DLC_Study_Guide.pptx"))
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const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Orris Medical AI";
pres.title = "DLC Study Guide";

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    { fontSize: 9, color: C.slateLight, align: "center", italic: true });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — Title
// ════════════════════════════════════════════════════════════════════════════
{
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  // Left green panel
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  // Accent strip
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    { fontSize: 90, bold: true, color: C.white, align: "center" });
  txt(s, "Study Guide", 0.3, 2.3, 3.0, 0.9,
    { fontSize: 22, bold: true, color: "A7F3D0", align: "center" });

  txt(s, "Differential Leukocyte Count", 4.0, 1.2, 5.6, 0.7,
    { fontSize: 26, bold: true, color: C.green, align: "left" });
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    { fontSize: 18, color: C.slateLight, italic: true, align: "left" });

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    "Henry's Clinical Diagnosis & Management by Laboratory Methods (23e)",
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  });

  txt(s, "For educational use only", 4.0, 5.2, 5.6, 0.3,
    { fontSize: 9, color: C.border, italic: true, align: "left" });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — What Is DLC + Normal Ranges
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "What Is the DLC?");

  txt(s, "The DLC quantifies the relative (%) and absolute (cells/µL) concentration of each leukocyte type in peripheral blood as part of the automated CBC.",
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  note(s, "Key principle: Always interpret the ABSOLUTE count (WBC × % ÷ 100), not percentage alone — a raised % may just reflect depletion of another cell type.", 1.52);

  txt(s, "Normal Total WBC (Adults):  4,000 – 7,000 cells/µL  (broader ref: 4,500 – 11,000 /µL)",
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  table3(s,
    ["Cell Type", "% of WBC", "Absolute (×10³/µL)"],
    [
      ["Neutrophils (segs + bands)", "50 – 70%",  "1.8 – 7.0  |  Bands <5%"],
      ["Lymphocytes",                "20 – 40%",  "1.0 – 4.8  |  Dominant <4 yrs"],
      ["Monocytes",                  "2 – 10%",   "0.2 – 1.0  |  Largest WBC"],
      ["Eosinophils",                "1 – 4%",    "0.04 – 0.4  |  Allergy/parasites"],
      ["Basophils",                  "0 – 1%",    "0.01 – 0.1  |  Rarest; histamine"],
    ],
    PAD, 2.35, INNER, C.green
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — Neutrophilia
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "Neutrophilia", "Neutrophils > 7.0 ×10³/µL");

  // 3 mechanism cards
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    ["Demargination", "Exercise, epinephrine, stress — shifts cells from vessel walls into circulation. No increase in total pool."],
    ["Increased Marrow Output", "Cortisol, steroids, severe infections — drives release from marrow storage pool."],
    ["Decreased Egress", "Corticosteroids block neutrophil migration out of blood into tissues."],
  ];
  const cw = (INNER - 0.3) / 3;
  mechanisms.forEach(([title, body], i) => {
    card(s, PAD + i * (cw + 0.15), 1.02, cw, 1.15, title, C.greenMid,
      [{ text: body, options: { fontSize: 10, color: C.slate } }]);
  });

  table2(s,
    ["Category", "Key Examples"],
    [
      ["Infections",  "Bacterial (most common), fungal, some viral"],
      ["Inflammation","Trauma, surgery, burns, MI, post-splenectomy"],
      ["Drugs",       "Corticosteroids, G-CSF, lithium"],
      ["Physiologic", "Exercise, stress, pregnancy, neonatal"],
      ["Neoplastic",  "CML, myeloproliferative disorders"],
      ["Metabolic",   "Uremia, DKA, gout, thyrotoxicosis"],
    ],
    PAD, 2.28, INNER, C.green
  );

  note(s, "NOT neutrophilic (exceptions): TB, brucellosis, pertussis → lymphocytes dominant; Listeria → monocytes dominant.", 4.6);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — Left Shift & Toxic Changes
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "Left Shift & Toxic Changes in Neutrophils");

  // Left shift explanation (left panel)
  txt(s, "Left Shift", PAD, 1.05, 4.5, 0.3,
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  txt(s, [
    { text: "Release of immature neutrophils:\n", options: { bold: true } },
    { text: "Bands  →  Metamyelocytes  →  Myelocytes\n\n", options: {} },
    { text: "Reactive left shift ", options: { bold: true } },
    { text: "rarely includes promyelocytes or blasts.\nPromyelocytes/blasts suggest ", options: {} },
    { text: "leukemia", options: { bold: true, color: C.red } },
    { text: ", not reactive disease.", options: {} },
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       fontFace: "Calibri", fontSize: 11, color: C.slate, valign: "top", margin: 0 });

  // Toxic changes (right panel)
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    ["Toxic Granulation", C.green,   "Dark azurophilic (primary) granules in cytoplasm. Severe infections, toxic conditions, reactive states."],
    ["Döhle Bodies",      C.greenMid,"Pale-blue oval cytoplasmic inclusions (ribosome remnants). Infections and toxic states."],
    ["Cytoplasmic Vacuoles", C.teal, "Empty vacuoles indicating active phagocytosis. Infection."],
  ];
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    card(s, 5.05, 1.05 + i * 0.88, 4.5, 0.82, title, color,
      [{ text: body, options: { fontSize: 10, color: C.slate } }]);
  });

  // Anomalies table at bottom
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    ["Anomaly", "Description", "Significance"],
    [
      ["Pelger-Huët",     "Bilobed / pince-nez nucleus",          "Inherited (benign) or MDS"],
      ["Hypersegmentation","≥5 lobes in ≥5% of neutrophils",      "B12 / folate deficiency"],
      ["May-Hegglin",     "Döhle-like inclusions + giant platelets","Rare autosomal-dominant"],
      ["Chédiak-Higashi", "Giant fused lysosomes in all WBCs",    "AR; recurrent infections + albinism"],
    ],
    PAD, 3.75, INNER, C.slateLight
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — Neutropenia
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "Neutropenia", "Absolute neutrophils < 1.8 ×10³/µL");

  // Severity stat badges
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    ["1.0 – 1.8", "Mild",     C.greenLight],
    ["0.5 – 1.0", "Moderate", C.amberLight],
    ["< 0.5",     "Severe / Agranulocytosis  ⚠", C.redLight],
  ];
  const bw = (INNER - 0.4) / 3;
  grades.forEach(([val, label, bg], i) => {
    statBadge(s, PAD + i * (bw + 0.2), 1.02, bw, 0.85, val + " ×10³/µL", label, bg);
  });

  table2(s,
    ["Category", "Key Examples"],
    [
      ["Drugs (most common)", "Chemo, chloramphenicol, sulfonamides, phenothiazines, anticonvulsants"],
      ["Radiation",           "Dose-dependent marrow damage; lymphocytes most radiosensitive"],
      ["Immune-mediated",     "SLE, RA / Felty syndrome, AIDS — immune-mediated destruction"],
      ["Congenital",          "Kostmann syndrome, cyclic neutropenia (~21-day cycle; ELA2 mutation)"],
      ["Hematologic",         "Megaloblastic anemia, MDS, aplastic anemia, marrow infiltration"],
      ["Infectious",          "Overwhelming bacterial sepsis; viral suppression (measles, rubella)"],
      ["Other",               "Starvation, hypersplenism, alcohol, benzene toxicity"],
    ],
    PAD, 1.98, INNER, C.green
  );

  note(s, "Toxic granulation + Döhle bodies seen in infection-related neutropenia — absent in PIH (pregnancy-induced hypertension). Clinically useful distinction.", 4.6);
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — Lymphocytes
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "Lymphocytes");

  // Left: Lymphocytosis
  rect(s, PAD, 1.02, 4.5, 0.3, C.green);
  txt(s, "Lymphocytosis  > 4.8 ×10³/µL",
    PAD + 0.1, 1.02, 4.3, 0.3, { fontSize: 11, bold: true, color: C.white });

  table2(s,
    ["Category", "Examples"],
    [
      ["Acute viral", "EBV (mono), CMV, hepatitis, rubella, pertussis"],
      ["Chronic infections", "TB, brucellosis, toxoplasmosis"],
      ["Autoimmune", "Early RA, other autoimmune disorders"],
      ["Neoplastic", "CLL, ALL, lymphomas"],
    ],
    PAD, 1.35, 4.5, C.greenMid
  );

  note(s, "Reactive (atypical) lymphocytes: large, blue-gray cytoplasm, kidney-shaped nucleus — classic in EBV mono.", 2.95);

  // Right: Lymphopenia
  rect(s, 5.1, 1.02, 4.45, 0.3, C.red);
  txt(s, "Lymphopenia  < 1.0 ×10³/µL",
    5.2, 1.02, 4.25, 0.3, { fontSize: 11, bold: true, color: C.white });

  table2(s,
    ["Category", "Examples"],
    [
      ["Immunodeficiency", "HIV/AIDS, DiGeorge syndrome, SCID"],
      ["Adrenocortical excess", "Cushing's, high-dose corticosteroids"],
      ["Cytotoxic therapy", "Chemo, radiation (most radiosensitive WBC)"],
      ["Advanced malignancy", "Lymphomas, advanced carcinomas"],
      ["Other", "Anorexia nervosa, impaired intestinal lymphatics"],
    ],
    5.1, 1.35, 4.45, C.red
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — Monocytes & Eosinophils
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "Monocytes & Eosinophils");

  // Monocytosis
  rect(s, PAD, 1.02, 4.5, 0.3, C.green);
  txt(s, "Monocytosis  > 1.0 ×10³/µL",
    PAD + 0.1, 1.02, 4.3, 0.3, { fontSize: 11, bold: true, color: C.white });
  table2(s,
    ["Category", "Examples"],
    [
      ["Infections", "TB, brucellosis, SBE, Listeria, protozoa"],
      ["Hematologic", "AML-M5, AML-M4, MDS"],
      ["Inflammatory", "SLE, IBD, sarcoidosis"],
      ["Recovery / other", "Post-chemo; sprue; ulcerative colitis"],
    ],
    PAD, 1.35, 4.5, C.greenMid
  );
  note(s, "Listeria → monocyte-predominant response, esp. in neonates.", 2.95);
  txt(s, "Monocytopenia: onset of steroids; hairy cell leukemia (classic).",
    PAD, 3.42, 4.5, 0.3, { fontSize: 10, color: C.slateLight, italic: true });

  // Eosinophilia
  rect(s, 5.1, 1.02, 4.45, 0.3, C.teal);
  txt(s, "Eosinophilia  > 0.4 ×10³/µL",
    5.2, 1.02, 4.25, 0.3, { fontSize: 11, bold: true, color: C.white });

  const eSeverity = [
    ["Mild: 0.4–1.5 ×10³/µL", C.greenLight, C.green],
    ["Moderate: 1.5–5.0 ×10³/µL", C.amberLight, C.amber],
    ["Severe / HES: > 5.0 ×10³/µL ⚠", C.redLight, C.red],
  ];
  eSeverity.forEach(([label, bg, tc], i) => {
    rect(s, 5.1, 1.35 + i * 0.26, 4.45, 0.24, bg, C.border);
    txt(s, label, 5.2, 1.35 + i * 0.26, 4.25, 0.24,
      { fontSize: 10, bold: true, color: tc });
  });

  table2(s,
    ["Category", "Examples"],
    [
      ["Allergic", "Asthma, hay fever, urticaria, atopic dermatitis"],
      ["Parasitic", "Tissue-invasive helminths (Ascaris, hookworm, Toxocara)"],
      ["Neoplastic", "CML, Hodgkin lymphoma, eosinophilic leukemia"],
      ["Other", "Addison disease, Löffler syndrome, drug reactions"],
    ],
    5.1, 2.15, 4.45, C.teal
  );
  txt(s, "Eosinopenia: acute stress, Cushing's, corticosteroids.",
    5.1, 3.8, 4.45, 0.3, { fontSize: 10, color: C.slateLight, italic: true });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — Basophils
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "Basophils");

  // Definition
  rect(s, PAD, 1.02, INNER, 0.3, C.green);
  txt(s, "Basophilia  > 0.1 ×10³/µL  |  Basopenia < 0.01 ×10³/µL",
    PAD + 0.1, 1.02, INNER - 0.2, 0.3, { fontSize: 12, bold: true, color: C.white });

  table2(s,
    ["Category", "Basophilia Causes"],
    [
      ["Hematologic (most specific)", "CML (very characteristic), polycythemia vera, myeloid metaplasia"],
      ["Inflammatory / allergic", "Hypersensitivity reactions, chronic sinusitis, ulcerative colitis"],
      ["Endocrine", "Hypothyroidism"],
      ["Other", "Chronic hemolytic anemia, splenectomy, ionizing radiation"],
    ],
    PAD, 1.38, INNER, C.greenMid
  );

  note(s, "Persistent basophilia + neutrophilia + eosinophilia = strongly suspect CML. Send BCR-ABL (Philadelphia chromosome) testing.", 2.72);

  rect(s, PAD, 3.2, INNER, 0.3, C.slateLight);
  txt(s, "Basopenia Causes:  Sustained glucocorticoids  |  Acute infection or stress  |  Hyperthyroidism",
    PAD + 0.1, 3.2, INNER - 0.2, 0.3, { fontSize: 11, color: C.white });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — Quick Pattern Recognition
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "Quick Pattern Recognition");

  table2(s,
    ["DLC Pattern", "Suspect First"],
    [
      ["Neutrophilia + left shift + toxic changes",   "Bacterial infection / sepsis"],
      ["Neutrophilia alone, no toxic changes",        "Physiologic stress or corticosteroids"],
      ["Neutropenia, no toxic changes",               "Drug-induced, PIH, or immune-mediated"],
      ["Lymphocytosis + atypical lymphocytes",        "EBV infectious mononucleosis"],
      ["Lymphocytosis + mature small lymphocytes",    "CLL (chronic lymphocytic leukemia)"],
      ["Eosinophilia (mild–moderate)",                "Allergy / atopic disease"],
      ["Eosinophilia (marked, >5 ×10³/µL)",          "Tissue-invasive parasites"],
      ["Basophilia",                                  "CML — until proven otherwise"],
      ["Monocytosis",                                 "TB, chronic infection, or AML-M5"],
      ["Lymphopenia",                                 "HIV/AIDS, corticosteroids, radiation"],
      ["Pancytopenia",                                "Aplastic anemia, marrow infiltration, megaloblastic anemia"],
      ["Neutrophilia + basophilia + eosinophilia",    "CML (leukemoid reaction if BCR-ABL negative)"],
    ],
    PAD, 1.02, INNER, C.green
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — Disease Patterns
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "DLC Patterns in Specific Diseases");

  table2(s,
    ["Disease", "Classic DLC Pattern"],
    [
      ["Bacterial sepsis",          "Neutrophilia + left shift + toxic granulation + Döhle bodies"],
      ["EBV mononucleosis",         "Lymphocytosis with atypical (reactive) lymphocytes"],
      ["CML",                       "Neutrophilia + basophilia + eosinophilia; BCR-ABL positive"],
      ["CLL",                       "Mature small lymphocytosis; smudge cells on film"],
      ["Pertussis",                 "Lymphocytosis (unusually, for a bacterial infection)"],
      ["Tuberculosis",              "Lymphocytosis or monocytosis; possible neutropenia"],
      ["HIV/AIDS",                  "Lymphopenia (CD4+ depletion) + neutropenia"],
      ["Felty syndrome",            "Neutropenia + RA + splenomegaly"],
      ["B12 / folate deficiency",   "Hypersegmented neutrophils; pancytopenia; macrocytic anemia"],
      ["Cushing's syndrome",        "Neutrophilia + lymphopenia + eosinopenia"],
      ["Addison's disease",         "Eosinophilia + lymphocytosis + neutropenia"],
      ["Listeria (neonates)",       "Monocyte-predominant response"],
    ],
    PAD, 1.02, INNER, C.green
  );
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — Formulas
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  chrome(s, "Key Formulas");

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    rect(s, PAD + i * (fw + 0.2), 1.1, fw, 1.2, bg, C.border);
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  });

  // Sources
  rect(s, PAD, 2.55, INNER, 0.3, C.green);
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    { fontSize: 12, bold: true, color: C.white });

  const sources = [
    "Henry's Clinical Diagnosis and Management by Laboratory Methods, 23rd edition",
    "Goldman-Cecil Medicine (International Edition)",
    "Textbook of Family Medicine, 9th edition",
    "Tietz Textbook of Laboratory Medicine, 7th edition  |  Quick Compendium of Clinical Pathology, 5th edition",
  ];
  sources.forEach((src, i) => {
    txt(s, `${i + 1}.  ${src}`, PAD, 2.9 + i * 0.3, INNER, 0.28,
      { fontSize: 10, color: C.slateLight, italic: true });
  });
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — End
// ════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.white };
  rect(s, 0, 0, 3.6, SH, C.green);
  rect(s, 3.6, 0, 0.08, SH, C.greenMid);

  txt(s, "Thank\nYou", 0.2, 0.4, 3.2, 3.2,
    { fontSize: 54, bold: true, color: C.white, align: "center", valign: "middle" });
  txt(s, "DLC Study Guide", 3.9, 1.5, 5.7, 0.7,
    { fontSize: 28, bold: true, color: C.green, align: "left" });
  txt(s, "Differential Leukocyte Count\nNormal vs. Abnormal Patterns", 3.9, 2.25, 5.7, 0.8,
    { fontSize: 15, color: C.slateLight, italic: true, align: "left" });

  rect(s, 3.9, 3.2, 5.7, 0.04, C.greenLight);
  txt(s, "For educational purposes only  |  Always verify clinical decisions against current guidelines.",
    3.9, 3.3, 5.7, 0.4, { fontSize: 9.5, color: C.border, italic: true, align: "left" });
}

// ── Write ─────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/dlc-study-guide/DLC_Study_Guide_v2.pptx" })
  .then(() => console.log("Done"))
  .catch(e => { console.error(e); process.exit(1); });

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Orris Medical AI";
pres.title = "DLC Study Guide";

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function hr(s, y) { R(s, PAD, y, IW, 0.04, C.mint); }

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 — TITLE
// ─────────────────────────────────────────────────────────────────────────────
{
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  T(s, "DLC", 0.35, 1.15, 5.2, 1.8,
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  T(s, "Study Guide", 0.42, 2.95, 5.2, 0.7,
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  T(s, "Differential Leukocyte Count", 0.42, 3.7, 5.2, 0.4,
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  R(s, 0.42, SH - 0.35, 5.2, 0.04, C.gold);
  T(s, "Henry's Clinical Diagnosis & Management (23e)  |  Goldman-Cecil  |  Family Medicine (9e)  |  Tietz (7e)",
    0.42, SH - 0.3, 5.2, 0.28,
    { fontSize: 8.5, color: C.muted, italic: true });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 — OVERVIEW: What Is the DLC?
// ─────────────────────────────────────────────────────────────────────────────
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  stats.forEach(([val, lbl, bg], i) => {
    badge(s, PAD + i * (sw2 + 0.2), 1.9, sw2, 0.82, val, lbl, bg);
  });

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    ["Cell Type", "% of WBC (Adult)", "Absolute ×10³/µL"],
    [
      ["Neutrophils (segs + bands)", "50–70%",  "1.8–7.0  ·  Bands <5%"],
      ["Lymphocytes",                "20–40%",  "1.0–4.8  ·  Dominant <4 yrs"],
      ["Monocytes",                  "2–10%",   "0.2–1.0  ·  Largest WBC"],
      ["Eosinophils",                "1–4%",    "0.04–0.4  ·  Allergy/parasites"],
      ["Basophils",                  "0–1%",    "0.01–0.1  ·  Histamine carrier"],
    ],
    PAD, 2.82, IW
  );
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3 — NEUTROPHILIA
// ─────────────────────────────────────────────────────────────────────────────
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  chrome(s, "Neutrophilia", "NEUTROPHILS ↑");

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    ["↑ Marrow Output",     "Infection, corticosteroids, G-CSF stimulate release from bone marrow storage pool."],
    ["↓ Tissue Egress",     "Corticosteroids block neutrophil migration out of blood into tissues."],
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      ["Infections",    "Bacterial (most common), fungal, some viral"],
      ["Inflammation",  "Trauma, surgery, burns, MI"],
      ["Drugs",         "Corticosteroids, G-CSF, lithium"],
      ["Physiologic",   "Exercise, stress, pregnancy, neonatal"],
      ["Neoplastic",    "CML, myeloproliferative disorders"],
      ["Metabolic",     "Uremia, DKA, gout"],
    ],
    PAD, 2.2, IW
  );

  note(s, "⚠ Exceptions: TB · brucellosis · pertussis → lymphocyte-dominant.  Listeria → monocyte-dominant.", 4.58, "!");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4 — LEFT SHIFT & TOXIC CHANGES
// ─────────────────────────────────────────────────────────────────────────────
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    { text: "rarely includes promyelocytes or blasts.\n", options: { fontSize: 11 } },
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    ["Döhle Bodies",        C.emerald, "Pale-blue oval cytoplasmic ribosome remnants. Infections and toxic states."],
    ["Cytoplasmic Vacuoles",C.sage,    "Empty vacuoles — indicate active phagocytosis during infection."],
  ];
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    ["Anomaly", "Description", "Significance"],
    [
      ["Pelger-Huët",      "Bilobed / pince-nez nucleus",         "Inherited (benign) or MDS"],
      ["Hypersegmentation","≥5 lobes in ≥5% neutrophils",         "B12 / folate deficiency"],
      ["Alder-Reilly",     "Prominent azurophilic granulation",    "Mucopolysaccharidoses; NOT infection"],
      ["Chédiak-Higashi",  "Giant fused lysosomes in ALL WBCs",   "AR; pyogenic infections + albinism"],
    ],
    PAD, 3.68, IW, C.muted
  );
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5 — NEUTROPENIA
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  chrome(s, "Neutropenia", "NEUTROPHILS ↓");

  // Severity badges
  const grades = [
    ["1.0–1.8 ×10³/µL", "MILD",     C.mint,       C.forest],
    ["0.5–1.0 ×10³/µL", "MODERATE", C.goldLight,  C.forest],
    ["< 0.5 ×10³/µL",   "SEVERE ⚠", C.roseLight,  C.rose],
  ];
  const bw = (IW - 0.4) / 3;
  grades.forEach(([val, lbl, bg, tc], i) => {
    badge(s, PAD + i * (bw + 0.2), 1.0, bw, 0.88, val, lbl, bg, tc);
  });

  tbl2(s, "Category", "Key Examples",
    [
      ["Drugs (most common)", "Chemo · chloramphenicol · sulfonamides · phenothiazines · anticonvulsants"],
      ["Radiation",           "Dose-dependent marrow damage; lymphocytes most radiosensitive"],
      ["Immune-mediated",     "SLE · RA/Felty syndrome · AIDS"],
      ["Congenital",          "Kostmann · cyclic neutropenia (ELA2, ~21-day cycle) · Chédiak-Higashi"],
      ["Hematologic",         "Megaloblastic anemia · MDS · aplastic anemia · marrow infiltration"],
      ["Infectious",          "Overwhelming bacterial sepsis; measles, rubella (viral suppression)"],
      ["Other",               "Starvation · hypersplenism · alcohol · benzene"],
    ],
    PAD, 1.98, IW
  );

  note(s, "Toxic granulation + Döhle bodies present in infection-related neutropenia — ABSENT in PIH. Clinically useful distinction.", 4.6);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6 — LYMPHOCYTES
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  chrome(s, "Lymphocytes", "LYMPHOCYTES");

  // Left half — Lymphocytosis
  R(s, PAD, 1.0, 4.5, 0.32, C.forest);
  T(s, "↑ Lymphocytosis  > 4.8 ×10³/µL",
    PAD + 0.1, 1.0, 4.3, 0.32,
    { fontSize: 11, bold: true, color: C.white });
  tbl2(s, "Category", "Examples",
    [
      ["Acute viral (most common)", "EBV (mono), CMV, hepatitis, rubella, pertussis"],
      ["Chronic infections",        "TB, brucellosis, toxoplasmosis"],
      ["Autoimmune",                "Early RA, other autoimmune disorders"],
      ["Neoplastic",                "CLL, ALL, lymphomas"],
    ],
    PAD, 1.35, 4.5, C.emerald, 0.285
  );
  note(s, "Reactive (atypical) lymphocytes: large, blue-gray cytoplasm, kidney-shaped nucleus — classic in EBV mono.", 2.9, "★");

  // Right half — Lymphopenia
  R(s, 5.1, 1.0, 4.46, 0.32, C.rose);
  T(s, "↓ Lymphopenia  < 1.0 ×10³/µL",
    5.2, 1.0, 4.26, 0.32,
    { fontSize: 11, bold: true, color: C.white });
  tbl2(s, "Category", "Examples",
    [
      ["Immunodeficiency",     "HIV/AIDS, DiGeorge syndrome, SCID"],
      ["Adrenocortical excess","Cushing's, high-dose corticosteroids"],
      ["Cytotoxic therapy",    "Chemo · radiation (most radiosensitive WBC)"],
      ["Advanced malignancy",  "Lymphomas, advanced carcinomas"],
      ["Other",                "Anorexia nervosa, impaired intestinal lymphatics"],
    ],
    5.1, 1.35, 4.46, C.rose, 0.285
  );
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7 — MONOCYTES & EOSINOPHILS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  chrome(s, "Monocytes & Eosinophils");

  // ── Monocytes ──
  R(s, PAD, 1.0, 4.5, 0.32, C.forest);
  T(s, "Monocytosis  > 1.0 ×10³/µL",
    PAD + 0.1, 1.0, 4.3, 0.32,
    { fontSize: 11, bold: true, color: C.white });
  tbl2(s, "Category", "Examples",
    [
      ["Infections",    "TB · brucellosis · SBE · Listeria · protozoa"],
      ["Hematologic",   "AML-M5, AML-M4, MDS"],
      ["Inflammatory",  "SLE, IBD, sarcoidosis"],
      ["Recovery",      "Post-chemo; monocytes recover before neutrophils"],
    ],
    PAD, 1.35, 4.5, C.emerald, 0.285
  );
  note(s, "Listeria → monocyte-predominant response, especially in neonates.", 2.9, "★");
  T(s, "Monocytopenia:  onset of steroids  |  hairy cell leukaemia (classic)",
    PAD, 3.4, 4.5, 0.3,
    { fontSize: 9.5, color: C.muted, italic: true });

  // ── Eosinophils ──
  R(s, 5.1, 1.0, 4.46, 0.32, C.sky);
  T(s, "Eosinophilia  > 0.4 ×10³/µL",
    5.2, 1.0, 4.26, 0.32,
    { fontSize: 11, bold: true, color: C.white });

  const eSev = [
    ["Mild 0.4–1.5",   C.mint,      C.forest],
    ["Moderate 1.5–5", C.goldLight, C.forest],
    ["Severe > 5.0 ⚠", C.roseLight, C.rose],
  ];
  const esw = 4.46 / 3;
  eSev.forEach(([lbl, bg, tc], i) => {
    R(s, 5.1 + i * esw, 1.35, esw, 0.3, bg, { line: { color: C.ghost, width: 0.5 } });
    T(s, lbl, 5.1 + i * esw + 0.06, 1.35, esw - 0.08, 0.3,
      { fontSize: 9.5, bold: true, color: tc, align: "center" });
  });

  tbl2(s, "Category", "Examples",
    [
      ["Allergic",   "Asthma, hay fever, urticaria, atopic dermatitis"],
      ["Parasitic",  "Tissue-invasive helminths (Ascaris, hookworm, Toxocara)"],
      ["Neoplastic", "CML · Hodgkin lymphoma · eosinophilic leukemia"],
      ["Other",      "Addison disease · Löffler syndrome · drug reactions"],
    ],
    5.1, 1.7, 4.46, C.sky, 0.285
  );
  T(s, "Eosinopenia:  acute stress  |  Cushing's  |  corticosteroids",
    5.1, 3.7, 4.46, 0.3,
    { fontSize: 9.5, color: C.muted, italic: true });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8 — BASOPHILS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  chrome(s, "Basophils", "BASOPHILS");

  R(s, PAD, 1.0, IW, 0.32, C.forest);
  T(s, "Basophilia  > 0.1 ×10³/µL",
    PAD + 0.1, 1.0, IW - 0.2, 0.32,
    { fontSize: 12, bold: true, color: C.white });

  tbl2(s, "Category", "Basophilia Causes",
    [
      ["Hematologic (most specific)", "CML (very characteristic) · polycythemia vera · myeloid metaplasia"],
      ["Inflammatory / allergic",     "Hypersensitivity reactions · chronic sinusitis"],
      ["Endocrine",                   "Hypothyroidism"],
      ["Other",                       "Chronic hemolytic anemia · splenectomy · ionizing radiation"],
    ],
    PAD, 1.36, IW
  );

  note(s, "Basophilia + neutrophilia + eosinophilia = suspect CML immediately. Send BCR-ABL / Philadelphia chromosome testing.", 2.76);

  R(s, PAD, 3.26, IW, 0.32, C.muted);
  T(s, "Basopenia:  Sustained glucocorticoids  |  Acute infection / stress  |  Hyperthyroidism",
    PAD + 0.1, 3.26, IW - 0.2, 0.32,
    { fontSize: 11, bold: true, color: C.white });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9 — QUICK PATTERN RECOGNITION
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  chrome(s, "Quick Pattern Recognition", "CLINICAL PEARLS");

  tbl2(s, "DLC Pattern", "First Diagnosis to Suspect",
    [
      ["Neutrophilia + left shift + toxic changes",  "Bacterial infection / sepsis"],
      ["Neutrophilia alone, no toxic changes",       "Physiologic stress or corticosteroids"],
      ["Neutropenia, no toxic changes",              "Drug-induced · PIH · immune-mediated"],
      ["Lymphocytosis + atypical lymphocytes",       "EBV infectious mononucleosis"],
      ["Lymphocytosis + mature small lymphocytes",   "CLL (chronic lymphocytic leukaemia)"],
      ["Eosinophilia (mild–moderate)",               "Allergy / atopic disease"],
      ["Eosinophilia (marked > 5 ×10³/µL)",         "Tissue-invasive parasites"],
      ["Basophilia",                                 "CML — until proven otherwise"],
      ["Monocytosis",                                "TB · chronic infection · AML-M5"],
      ["Lymphopenia",                                "HIV/AIDS · corticosteroids · radiation"],
      ["Pancytopenia",                               "Aplastic anemia · marrow infiltration · megaloblastic anemia"],
      ["Neutrophilia + basophilia + eosinophilia",   "CML (leukemoid reaction if BCR-ABL negative)"],
    ],
    PAD, 1.0, IW, C.forest, 0.275
  );
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10 — DISEASE PATTERNS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  chrome(s, "DLC Patterns in Specific Diseases", "DIAGNOSIS");

  tbl2(s, "Disease", "Classic DLC Pattern",
    [
      ["Bacterial sepsis",        "Neutrophilia + left shift + toxic granulation + Döhle bodies"],
      ["EBV mononucleosis",       "Lymphocytosis with atypical (reactive) lymphocytes"],
      ["CML",                     "Neutrophilia + basophilia + eosinophilia; BCR-ABL positive"],
      ["CLL",                     "Mature small lymphocytosis; smudge cells on blood film"],
      ["Pertussis",               "Lymphocytosis (unusually, for a bacterial infection)"],
      ["HIV/AIDS",                "Lymphopenia (CD4+ depletion) + neutropenia"],
      ["Felty syndrome",          "Neutropenia + RA + splenomegaly"],
      ["B12 / folate deficiency", "Hypersegmented neutrophils; pancytopenia; macrocytic anemia"],
      ["Cushing's syndrome",      "Neutrophilia + lymphopenia + eosinopenia"],
      ["Addison's disease",       "Eosinophilia + lymphocytosis + neutropenia"],
      ["Listeria (neonates)",     "Monocyte-predominant response"],
      ["Tuberculosis",            "Lymphocytosis or monocytosis; possible neutropenia"],
    ],
    PAD, 1.0, IW, C.forest, 0.275
  );
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11 — KEY FORMULAS & SOURCES
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  chrome(s, "Key Formulas & References", "SUMMARY");

  const fw = (IW - 0.24) / 2;

  // Formula cards
  [
    ["Absolute Cell Count", "Total WBC  ×  (% cell type ÷ 100)", C.mint, C.forest],
    ["Corrected WBC (nRBCs)", "WBC × 100 ÷ (100 + nRBCs per 100 WBCs)", C.goldLight, C.forest],
  ].forEach(([title, formula, bg, tc], i) => {
    // Shadow
    R(s, PAD + i * (fw + 0.24) + 0.04, 1.04, fw, 1.1, C.ash);
    // Card
    R(s, PAD + i * (fw + 0.24), 1.0, fw, 1.1, bg, { line: { color: C.ghost, width: 1 } });
    R(s, PAD + i * (fw + 0.24), 1.0, fw, 0.08, C.gold);  // top gold bar
    T(s, title, PAD + i * (fw + 0.24) + 0.12, 1.14, fw - 0.24, 0.32,
      { fontSize: 12, bold: true, color: tc });
    T(s, formula, PAD + i * (fw + 0.24) + 0.12, 1.5, fw - 0.24, 0.5,
      { fontSize: 13, color: C.ink, italic: true, align: "center" });
  });

  // Sources
  R(s, PAD, 2.25, IW, 0.32, C.forest);
  T(s, "References", PAD + 0.1, 2.25, IW - 0.2, 0.32,
    { fontSize: 12, bold: true, color: C.white });

  const refs = [
    "Henry's Clinical Diagnosis and Management by Laboratory Methods, 23rd edition",
    "Goldman-Cecil Medicine (International Edition)",
    "Textbook of Family Medicine, 9th edition",
    "Tietz Textbook of Laboratory Medicine, 7th edition",
    "Quick Compendium of Clinical Pathology, 5th edition",
  ];
  refs.forEach((r, i) => {
    T(s, `${i + 1}.  ${r}`, PAD + 0.06, 2.62 + i * 0.28, IW - 0.12, 0.26,
      { fontSize: 9.5, color: C.muted, italic: true });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 12 — CLOSING
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: C.forest };

  // Decorative elements
  R(s, 0, 0, SW, 0.1, C.gold);
  R(s, 0, SH - 0.1, SW, 0.1, C.gold);
  R(s, 0, 0.1, 0.12, SH - 0.2, C.emerald);

  T(s, "Thank You", 0.5, 0.7, SW - 1, 2.0,
    { fontSize: 68, bold: true, color: C.white, align: "center" });

  R(s, 2.5, 2.8, SW - 5, 0.07, C.gold);

  T(s, "DLC Study Guide  —  Differential Leukocyte Count: Normal vs. Abnormal Patterns",
    0.5, 2.95, SW - 1, 0.5,
    { fontSize: 15, color: C.goldMid, align: "center" });

  T(s, "For educational purposes only  |  Always verify clinical decisions against current guidelines",
    0.5, 4.9, SW - 1, 0.35,
    { fontSize: 10, color: C.muted, align: "center", italic: true });
}

// ─────────────────────────────────────────────────────────────────────────────
// WRITE
// ─────────────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/dlc-study-guide/DLC_Study_Guide_v3.pptx" })
  .then(() => console.log("Done"))
  .catch(e => { console.error(e); process.exit(1); });