Anemia — Complete Diagnostic Approach (Stepwise)

#!/usr/bin/env python3
"""
Anemia – Complete Diagnostic Approach
Single-page note-taking style infographic using Pillow
"""

from PIL import Image, ImageDraw, ImageFont
import math, os, textwrap

# ── Canvas ────────────────────────────────────────────────────────────────────
W, H = 3200, 4800
img = Image.new("RGB", (W, H), "#FAFAF8")
draw = ImageDraw.Draw(img)

# ── Colour palette ────────────────────────────────────────────────────────────
C = {
    "bg":        "#FAFAF8",
    "header_bg": "#1A2B4A",   # deep navy
    "micro_bg":  "#FFF3E0",   # warm orange tint
    "macro_bg":  "#E8F5E9",   # green tint
    "normo_bg":  "#E3F2FD",   # blue tint
    "hemo_bg":   "#FCE4EC",   # pink tint
    "box_bg":    "#FFFFFF",
    "border":    "#CFD8DC",
    "step_blue": "#1565C0",
    "step_text": "#FFFFFF",
    "navy":      "#1A2B4A",
    "orange":    "#E65100",
    "green":     "#2E7D32",
    "teal":      "#00695C",
    "red":       "#C62828",
    "purple":    "#6A1B9A",
    "text":      "#1C1C1E",
    "subtext":   "#455A64",
    "arrow":     "#37474F",
    "retic_hi":  "#D32F2F",
    "retic_lo":  "#1565C0",
    "micro_c":   "#E65100",
    "macro_c":   "#2E7D32",
    "normo_c":   "#0277BD",
    "gold":      "#F9A825",
    "light_line":"#B0BEC5",
}

# ── Font loader ───────────────────────────────────────────────────────────────
def font(size, bold=False, italic=False):
    candidates = []
    if bold and italic:
        candidates = ["/usr/share/fonts/truetype/dejavu/DejaVuSans-BoldOblique.ttf"]
    elif bold:
        candidates = ["/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf",
                      "/usr/share/fonts/truetype/liberation/LiberationSans-Bold.ttf"]
    elif italic:
        candidates = ["/usr/share/fonts/truetype/dejavu/DejaVuSans-Oblique.ttf"]
    else:
        candidates = ["/usr/share/fonts/truetype/dejavu/DejaVuSans.ttf",
                      "/usr/share/fonts/truetype/liberation/LiberationSans-Regular.ttf"]
    for p in candidates:
        if os.path.exists(p):
            return ImageFont.truetype(p, size)
    return ImageFont.load_default()

# ── Drawing helpers ───────────────────────────────────────────────────────────
def rrect(draw, xy, radius=18, fill="#FFF", outline=None, width=2):
    x0,y0,x1,y1 = xy
    r = radius
    draw.rounded_rectangle([x0,y0,x1,y1], radius=r, fill=fill,
                            outline=outline, width=width)

def text_c(draw, xy, txt, fnt, color="#1C1C1E", anchor="mm"):
    draw.text(xy, txt, font=fnt, fill=color, anchor=anchor)

def wrap_text(draw, x, y, txt, fnt, max_w, color="#1C1C1E", line_gap=6, anchor="la"):
    words = txt.split()
    lines, cur = [], ""
    for w in words:
        test = (cur + " " + w).strip()
        bb = draw.textbbox((0,0), test, font=fnt)
        if bb[2]-bb[0] <= max_w:
            cur = test
        else:
            if cur: lines.append(cur)
            cur = w
    if cur: lines.append(cur)
    lh = draw.textbbox((0,0),"Ag",font=fnt)[3] + line_gap
    for i,ln in enumerate(lines):
        draw.text((x, y+i*lh), ln, font=fnt, fill=color, anchor=anchor)
    return y + len(lines)*lh

def arrow(draw, x1,y1,x2,y2, color="#37474F", w=4, head=18):
    draw.line([(x1,y1),(x2,y2)], fill=color, width=w)
    angle = math.atan2(y2-y1, x2-x1)
    for da in [0.45, -0.45]:
        ax = x2 - head*math.cos(angle-da)
        ay = y2 - head*math.sin(angle-da)
        draw.line([(x2,y2),(ax,ay)], fill=color, width=w)

def badge(draw, cx, cy, r, fill, text, fnt, tcol="white"):
    draw.ellipse([cx-r,cy-r,cx+r,cy+r], fill=fill)
    draw.text((cx,cy), text, font=fnt, fill=tcol, anchor="mm")

def step_pill(draw, x, y, w, h, num, label, bg, fg="white"):
    rrect(draw, [x,y,x+w,y+h], radius=h//2, fill=bg)
    f_num  = font(32, bold=True)
    f_lbl  = font(28, bold=True)
    badge(draw, x+h//2, y+h//2, h//2-4, "#FFFFFF44", str(num), f_num, tcol="white")
    draw.text((x+h+14, y+h//2), label, font=f_lbl, fill=fg, anchor="lm")

def divider(draw, y, color="#B0BEC5", pad=60):
    draw.line([(pad,y),(W-pad,y)], fill=color, width=2)

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 1 – HEADER
# ═══════════════════════════════════════════════════════════════════════════════
rrect(draw, [0,0,W,170], radius=0, fill=C["header_bg"])
draw.text((W//2, 58),  "ANEMIA", font=font(86,bold=True),  fill="#FFFFFF", anchor="mm")
draw.text((W//2, 128), "Complete Diagnostic Approach – Stepwise Reference",
          font=font(34), fill="#90CAF9", anchor="mm")

# red bar accent
draw.rectangle([0,170,W,182], fill="#EF5350")

# ── Hb normal values strip ──
yy = 196
rrect(draw, [40,yy,W-40,yy+80], radius=14, fill="#E3F2FD", outline="#1565C0", width=2)
vals = [
    ("Adult ♂",  "≥13 g/dL"),
    ("Adult ♀",  "≥12 g/dL"),
    ("Pregnant", "≥11 g/dL"),
    ("Child",    "≥11 g/dL"),
    ("Newborn",  "17 g/dL"),
]
col_w = (W-80) // len(vals)
for i,(lbl,val) in enumerate(vals):
    cx = 40 + i*col_w + col_w//2
    draw.text((cx, yy+22), lbl, font=font(24, bold=True), fill=C["step_blue"], anchor="mm")
    draw.text((cx, yy+56), val, font=font(28, bold=True), fill=C["red"],       anchor="mm")
    if i < len(vals)-1:
        draw.line([(40+i*col_w+col_w, yy+8),(40+i*col_w+col_w, yy+72)], fill=C["light_line"], width=2)

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 2 – STEPS 1-2 (History + Physical) side by side
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 300
step_pill(draw, 40, y0, 420, 48, 1, "HISTORY", C["step_blue"])
step_pill(draw, 1640, y0, 520, 48, 2, "PHYSICAL EXAM", C["teal"])

# history box
rrect(draw, [40,y0+56,1580,y0+56+260], radius=14, fill="#E8EAF6", outline="#3949AB", width=2)
hist = [
    "• Prior anemia, iron pills, transfusions, blood donation",
    "• Menstrual hx: duration, pads/clots (premenopausal ♀)",
    "• Family hx: hemoglobinopathy, hereditary spherocytosis",
    "• Diet: vegan/vegetarian (B12↓), poor diet (folate↓), alcohol",
    "• GI: diarrhea (celiac/IBD), melena, NSAID use → occult loss",
    "• Meds: chemo, methotrexate, antiseizure, ACE inhibitors",
    "• Ethnicity/geography: sickle cell, thalassemia",
]
fy = y0+76
for h in hist:
    draw.text((60, fy), h, font=font(24), fill=C["text"]); fy+=34

# physical box
rrect(draw, [1640,y0+56,W-40,y0+56+260], radius=14, fill="#E0F2F1", outline="#00695C", width=2)
phys = [
    "• Pallor: conjunctiva, mucosa, nail beds",
    "• Tachycardia, flow murmur, dyspnoea",
    "• Splenomegaly → hemolysis / lymphoma",
    "• Koilonychia, glossitis → iron deficiency",
    "• Neuro signs (posterior column) → B12↓",
    "• Lymphadenopathy → lymphoma/leukemia",
    "• Rectal exam / FOBT → GI blood loss",
]
fy = y0+76
for p in phys:
    draw.text((1660, fy), p, font=font(24), fill=C["text"]); fy+=34

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 3 – STEP 3: CBC indices
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 640
step_pill(draw, 40, y0, 620, 48, 3, "CBC + RETICULOCYTE COUNT", C["purple"])

rrect(draw, [40,y0+56,W-40,y0+56+110], radius=14, fill="#F3E5F5", outline="#7B1FA2", width=2)
indices = [
    ("MCV",  "80–100 fL", "Size classification"),
    ("MCH",  "27–33 pg",  "Hb per cell"),
    ("MCHC", "32–36 g/dL","Hb concentration"),
    ("RDW",  "11.5–14.5%","Anisocytosis"),
    ("Retic","0.5–1.5%",  "Marrow output"),
]
cw = (W-80)//len(indices)
for i,(nm,nrm,desc) in enumerate(indices):
    cx = 40 + i*cw + cw//2
    draw.text((cx, y0+76),  nm,   font=font(28,bold=True), fill=C["purple"],  anchor="mm")
    draw.text((cx, y0+106), nrm,  font=font(24,bold=True), fill=C["red"],     anchor="mm")
    draw.text((cx, y0+134), desc, font=font(20),           fill=C["subtext"], anchor="mm")
    if i < len(indices)-1:
        draw.line([(40+i*cw+cw,y0+62),(40+i*cw+cw,y0+154)], fill=C["light_line"], width=2)

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 4 – RETICULOCYTE BRANCH (big infographic)
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 820
step_pill(draw, 40, y0, 820, 48, 4, "RETICULOCYTE COUNT – MASTER BRANCH POINT", C["red"])

# Central retic box
cx_retic = W//2
rrect(draw, [cx_retic-280, y0+60, cx_retic+280, y0+138], radius=20,
      fill="#B71C1C", outline="#FFCDD2", width=3)
draw.text((cx_retic, y0+99), "ABSOLUTE RETICULOCYTE COUNT",
          font=font(28,bold=True), fill="white", anchor="mm")

# LEFT branch – HIGH
lx = 240
rrect(draw, [40, y0+164, 980, y0+164+90], radius=16,
      fill=C["retic_hi"], outline="#EF9A9A", width=3)
draw.text((510, y0+164+30), "RETIC  HIGH  (>100K/μL)",
          font=font(30,bold=True), fill="white", anchor="mm")
draw.text((510, y0+164+62), "Bone marrow IS responding → Loss/Destruction",
          font=font(22), fill="#FFCDD2", anchor="mm")

arrow(draw, cx_retic-280, y0+99, 980, y0+164+45, color=C["retic_hi"], w=5)

# RIGHT branch – LOW
rrect(draw, [W-980, y0+164, W-40, y0+164+90], radius=16,
      fill=C["retic_lo"], outline="#90CAF9", width=3)
draw.text((W-510, y0+164+30), "RETIC  LOW  (<50K/μL)",
          font=font(30,bold=True), fill="white", anchor="mm")
draw.text((W-510, y0+164+62), "Bone marrow NOT responding → Underproduction",
          font=font(22), fill="#BBDEFB", anchor="mm")

arrow(draw, cx_retic+280, y0+99, W-980, y0+164+45, color=C["retic_lo"], w=5)

# Sub-boxes HIGH
yh = y0+280
hboxes = [
    ("BLEEDING?",     "GI loss, menstrual\noccult blood, trauma",        "#FF8F00"),
    ("HEMOLYSIS",     "LDH↑, Haptoglobin↓\nIndir. bili↑",               "#C62828"),
    ("IMMUNE",        "DAT+  →  AIHA\nanti-IgG/complement",             "#AD1457"),
    ("NON-IMMUNE",    "G6PD, HS, PNH\nHb electrophoresis",               "#6A1B9A"),
]
bw = 930//len(hboxes)
for i,(t,d,col) in enumerate(hboxes):
    bx = 40 + i*bw
    rrect(draw, [bx, yh, bx+bw-10, yh+110], radius=12, fill=col, outline=None)
    draw.text((bx+bw//2-5, yh+26), t,  font=font(22,bold=True), fill="white", anchor="mm")
    wrap_text(draw, bx+12, yh+44, d, font(19), bw-24, color="#FFECB3")

# Sub-boxes LOW  
lboxes = [
    ("MICROCYTIC\nMCV<80",   "Fe def · Thal\nACD · Sideroblastic", C["micro_c"]),
    ("NORMOCYTIC\nMCV80-100","Renal · Inflam\nAplastic · Endocrine",C["normo_c"]),
    ("MACROCYTIC\nMCV>100",  "B12/Folate def\nAlcohol · MDS",       C["macro_c"]),
    ("BONE MARROW\n(if unclear)", "Aplastic · MDS\nLeukemia · Myeloma","#4A148C"),
]
bw2 = 930//len(lboxes)
for i,(t,d,col) in enumerate(lboxes):
    bx = W-980 + i*bw2
    rrect(draw, [bx, yh, bx+bw2-10, yh+110], radius=12, fill=col, outline=None)
    for j,ln in enumerate(t.split("\n")):
        draw.text((bx+bw2//2-5, yh+22+j*26), ln, font=font(21,bold=True), fill="white", anchor="mm")
    wrap_text(draw, bx+12, yh+74, d, font(19), bw2-24, color="#FFFFFF")

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 5 – MCV CLASSIFICATION (3 columns)
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 1100
step_pill(draw, 40, y0, 700, 48, 5, "MCV-BASED CLASSIFICATION", C["navy"])

col_w3 = (W-80)//3
titles = ["MICROCYTIC  (MCV < 80 fL)", "NORMOCYTIC  (MCV 80–100 fL)", "MACROCYTIC  (MCV > 100 fL)"]
colors = [C["micro_bg"], C["normo_bg"], C["macro_bg"]]
borders = [C["micro_c"], C["normo_c"], C["macro_c"]]
hdr_cols= [C["micro_c"], C["normo_c"], C["macro_c"]]

micro_content = [
    ("Iron Deficiency",   "Ferritin↓, TIBC↑\nSat <10%, RDW↑"),
    ("Thalassemia",       "Ferritin N/↑, TIBC N\nRDW LOW, Hb electro"),
    ("Anemia of Inflam.", "Ferritin↑, TIBC↓\nhepcidin↑, Fe↓"),
    ("Sideroblastic",     "Ring sideroblasts\nFe↑, saturation↑"),
]
normo_content = [
    ("Renal disease",     "eGFR<60, EPO↓\nNormocytic, EPO Rx"),
    ("Anemia of Inflam.", "If early/mild\nCRP/ESR↑"),
    ("Aplastic anemia",   "Pancytopenia\nBM hypocellular"),
    ("Endocrinopathy",    "TSH, cortisol\nHypothyroid/Addison"),
    ("Marrow invasion",   "Teardrops, nRBCs\nBM biopsy"),
]
macro_content = [
    ("B12 deficiency",    "Oval macros\nHyperseg PMNs, MMA↑"),
    ("Folate deficiency", "Oval macros\nHomocysteine↑"),
    ("Alcohol/Liver",     "Round macros\nLFT abnormal"),
    ("Hypothyroidism",    "Round macros\nTSH↑"),
    ("MDS",               "Oval macros\nNormal B12/folate\n→ BM biopsy"),
]
all_content = [micro_content, normo_content, macro_content]

box_top = y0+56
for col,(title,bg,bord,hc,content) in enumerate(zip(titles,colors,borders,hdr_cols,all_content)):
    x0c = 40 + col*col_w3
    rrect(draw, [x0c, box_top, x0c+col_w3-12, box_top+580], radius=16, fill=bg, outline=bord, width=3)
    # header
    rrect(draw, [x0c, box_top, x0c+col_w3-12, box_top+46], radius=14, fill=hc)
    draw.text((x0c+(col_w3-12)//2, box_top+23), title, font=font(24,bold=True),
              fill="white", anchor="mm")
    iy = box_top+60
    for (nm,details) in content:
        # sub-item
        rrect(draw, [x0c+12, iy, x0c+col_w3-24, iy+90], radius=10,
              fill="white", outline=bord, width=1)
        draw.text((x0c+22, iy+14), "▶  "+nm, font=font(22,bold=True), fill=hc)
        wrap_text(draw, x0c+22, iy+40, details, font(19), col_w3-60, color=C["subtext"])
        iy += 100

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 6 – IRON STUDIES TABLE + DIFFERENTIAL
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 1730
step_pill(draw, 40, y0, 820, 48, 6, "IRON STUDIES: KEY DIFFERENTIAL", C["orange"])

# table
table_y = y0+60
cols_t = ["TEST", "IRON DEFICIENCY", "ANEMIA OF INFLAM.", "THALASSEMIA", "SIDEROBLASTIC"]
col_ws = [340, 480, 480, 380, 380]
col_xs = [40]
for w in col_ws[:-1]: col_xs.append(col_xs[-1]+w)

# header row
hrow_y = table_y
total_w = sum(col_ws)
rrect(draw, [40, hrow_y, 40+total_w, hrow_y+52], radius=10, fill=C["navy"])
for i,(c,cw,cx) in enumerate(zip(cols_t,col_ws,col_xs)):
    draw.text((cx+cw//2, hrow_y+26), c, font=font(22,bold=True), fill="white", anchor="mm")

rows = [
    ("Smear",         "Micro/hypo",          "Normal or micro/hypo",  "Micro+targeting",   "Variable"),
    ("Serum Fe",      "↓ (<30 μg/dL)",        "↓ (<50)",               "Normal–High",       "Normal–High"),
    ("TIBC",          "↑ (>360 μg/dL)",       "↓ (<300)",              "Normal",            "Normal"),
    ("Sat%",          "< 10%",               "10–20%",                "30–80%",            "30–80%"),
    ("Ferritin",      "↓ (<15 μg/L) ⚠",      "↑ (30–200)",            "↑ (50–300)",        "↑ (50–300)"),
    ("RDW",           "↑ HIGH",              "Normal",                "↓ LOW",             "Variable"),
    ("Hb Electro",    "Normal",              "Normal",                "Abnormal (β-thal)", "Normal"),
]
row_colors = ["#FFF8E1","#FFF3E0","#FFF8E1","#FFF3E0","#FFEBEE","#FFF8E1","#FFF3E0"]
highlight_cols = {"↓ (<15 μg/L) ⚠": "#EF5350", "↑ HIGH":"#E65100", "↓ LOW":"#1565C0",
                  "< 10%":"#C62828"}

for ri,(row) in enumerate(rows):
    ry = table_y + 52 + ri*54
    rrect(draw, [40, ry, 40+total_w, ry+54], radius=0, fill=row_colors[ri])
    for ci,(cell,cw,cx) in enumerate(zip(row,col_ws,col_xs)):
        clr = C["text"]
        for k,v in highlight_cols.items():
            if k in cell: clr=v; break
        fw = font(21,bold=(ci==0))
        draw.text((cx+cw//2, ry+27), cell, font=fw, fill=clr, anchor="mm")
    draw.line([(40,ry),(40+total_w,ry)], fill=C["light_line"], width=1)

# border around table
draw.rectangle([40, table_y, 40+total_w, table_y+52+len(rows)*54], outline=C["orange"], width=2)

# ferritin note
note_y = table_y + 52 + len(rows)*54 + 10
draw.text((60, note_y), "⚠  Ferritin is an acute-phase reactant — may be falsely NORMAL/HIGH in combined iron deficiency + inflammation. Use sTfR/log ferritin index to distinguish.",
          font=font(21,italic=True), fill=C["red"])

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 7 – PERIPHERAL SMEAR MORPHOLOGY TABLE (visual icons)
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 2310
step_pill(draw, 40, y0, 820, 48, 7, "PERIPHERAL BLOOD SMEAR – MORPHOLOGY GUIDE", C["teal"])

morph_data = [
    ("Microcytic\nHypochromic",  "Small cells, large central pallor\n>1/3 diameter",      "Iron def · Thalassemia · ACD",         "#FF8F00"),
    ("Macro-ovalocytes\n+ Hyperseg PMNs", "Large oval cells, PMN >5 lobes\n(megaloblastic)", "B12 / Folate deficiency · MDS",   "#2E7D32"),
    ("Spherocytes",              "No central pallor\n(sphere, not biconcave disc)",         "AIHA · Hereditary spherocytosis",      "#C62828"),
    ("Schistocytes",             "Red cell fragments\n(helmet cells, triangles)",           "TTP · HUS · DIC · Valve hemolysis",    "#AD1457"),
    ("Sickle cells",             "Elongated, crescent-shaped\ncells",                       "Sickle cell disease (HbSS/HbSC)",      "#4A148C"),
    ("Target cells",             "Bulls-eye/shooting-target\nappearance",                  "Thalassemia · Liver disease · HbC",    "#1565C0"),
    ("Teardrop cells\n+ nRBCs",  "Teardrop shape + nucleated RBCs\n+ immature WBCs",       "Myelofibrosis · Marrow infiltration",  "#37474F"),
    ("Basophilic\nStippling",    "Blue dots in RBCs\n(precipitated ribosomes)",             "Thalassemia · Lead poisoning",         "#6A1B9A"),
]

cols_m = 4
rows_m = math.ceil(len(morph_data)/cols_m)
bw_m = (W-80)//cols_m
bh_m = 140
my_start = y0+60

for idx,(nm,desc,dx,col) in enumerate(morph_data):
    mc = idx % cols_m
    mr = idx // cols_m
    mx = 40 + mc*bw_m
    my = my_start + mr*(bh_m+12)
    rrect(draw, [mx, my, mx+bw_m-10, my+bh_m], radius=12, fill="#FFFFFF", outline=col, width=3)
    # coloured left accent
    draw.rectangle([mx, my, mx+10, my+bh_m], fill=col)
    for j,ln in enumerate(nm.split("\n")):
        draw.text((mx+22, my+16+j*28), ln, font=font(22,bold=True), fill=col)
    wrap_text(draw, mx+22, my+66, desc, font(19), bw_m-50, color=C["subtext"])
    wrap_text(draw, mx+22, my+104, "→ "+dx, font(19,italic=True), bw_m-50, color=C["text"])

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 8 – HEMOLYSIS WORKUP
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 2680
step_pill(draw, 40, y0, 620, 48, 8, "HEMOLYSIS WORKUP", C["red"])

hemo_tests = [
    ("LDH",          "↑ (RBC enzyme released)", "#EF5350"),
    ("Haptoglobin",  "↓ (binds free Hb)", "#C62828"),
    ("Indirect bili","↑ (Hb breakdown)", "#FF8F00"),
    ("Urine Hb/Hemosidin","+ (intravascular)", "#AD1457"),
    ("DAT (Coombs)", "+ → immune AIHA", "#1565C0"),
    ("G6PD assay",   "Low → G6PD def", "#2E7D32"),
    ("Hb electrophoresis","Abnormal → hemoglobinopathy","#6A1B9A"),
    ("Flow cytometry","CD55/CD59 absent → PNH","#00695C"),
]

bw_h = (W-80)//4
for i,(nm,val,col) in enumerate(hemo_tests):
    hx = 40 + (i%4)*bw_h
    hy = y0+60 + (i//4)*90
    rrect(draw, [hx, hy, hx+bw_h-10, hy+82], radius=12, fill="#FFF",
          outline=col, width=2)
    draw.rectangle([hx, hy, hx+bw_h-10, hy+8], fill=col)
    draw.text((hx+16, hy+18), nm,  font=font(22,bold=True), fill=col)
    draw.text((hx+16, hy+48), val, font=font(20),           fill=C["text"])

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 9 – B12 vs FOLATE vs MDS
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 2940
step_pill(draw, 40, y0, 820, 48, 9, "MACROCYTIC: B12 vs FOLATE vs MDS", C["green"])

macro_cols = ["FEATURE", "B12 DEFICIENCY", "FOLATE DEFICIENCY", "MDS"]
macro_rows = [
    ("Serum B12",    "LOW  (<200 pg/mL)", "Normal",           "Normal"),
    ("Serum Folate", "Normal",            "LOW",              "Normal"),
    ("Homocysteine", "↑↑",               "↑↑",              "Normal"),
    ("MMA",          "↑↑ (B12-specific)","Normal",           "Normal"),
    ("Neurology",    "YES (post. column)","No",               "No"),
    ("Bone marrow",  "Megaloblastic",     "Megaloblastic",    "Dysplastic\n± ring sideroblasts"),
    ("Treatment",    "B12 IM/oral",       "Folic acid oral",  "Supportive / azacitidine"),
]
col_ws_m = [380, 520, 520, 460]
col_xs_m = [40]; 
for w in col_ws_m[:-1]: col_xs_m.append(col_xs_m[-1]+w)
t_total = sum(col_ws_m)
th = y0+60
rrect(draw, [40, th, 40+t_total, th+50], radius=10, fill=C["green"])
for c,cw,cx in zip(macro_cols, col_ws_m, col_xs_m):
    draw.text((cx+cw//2, th+25), c, font=font(22,bold=True), fill="white", anchor="mm")

for ri,row in enumerate(macro_rows):
    ry = th+50+ri*60
    fill = "#F1F8E9" if ri%2==0 else "#FFFFFF"
    draw.rectangle([40,ry,40+t_total,ry+60], fill=fill)
    for ci,(cell,cw,cx) in enumerate(zip(row,col_ws_m,col_xs_m)):
        clr = C["red"] if "LOW" in cell and ci<2 else (C["green"] if ci==0 else C["text"])
        if "↑↑" in cell: clr=C["red"]
        wrap_text(draw, cx+8, ry+12, cell, font(20,bold=(ci==0)), cw-16, color=clr)
    draw.line([(40,ry),(40+t_total,ry)], fill=C["light_line"],width=1)
draw.rectangle([40,th,40+t_total,th+50+len(macro_rows)*60], outline=C["green"],width=2)

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 10 – BONE MARROW INDICATIONS
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 3400
step_pill(draw, 40, y0, 620, 48, 10, "BONE MARROW BIOPSY – INDICATIONS", "#4A148C")

bm_indications = [
    "Unexplained severe / refractory anemia",
    "Pancytopenia",
    "Myelophthisic picture (teardrops + nRBCs + leukoerythroblastosis)",
    "Macro-ovalocytes with normal B12 / folate → suspect MDS",
    "Suspected aplastic anemia",
    "Staging of lymphoma, myeloma, other malignancies",
    "Unexplained circulating blasts or nucleated RBCs",
]
rrect(draw, [40, y0+60, W//2-20, y0+60+270], radius=14, fill="#EDE7F6", outline="#4A148C", width=2)
for i,ind in enumerate(bm_indications):
    draw.text((70, y0+84+i*36), f"{'①②③④⑤⑥⑦'[i]}  {ind}", font=font(22), fill=C["text"])

# BM findings box
rrect(draw, [W//2+20, y0+60, W-40, y0+60+270], radius=14, fill="#EDE7F6", outline="#4A148C", width=2)
draw.text((W//2+40, y0+82), "BM FINDINGS:", font=font(24,bold=True), fill="#4A148C")
bm_finds = [
    ("Hypocellular marrow",        "→ Aplastic anemia"),
    ("Absent erythroid precursors","→ Pure red cell aplasia"),
    ("Ring sideroblasts",          "→ Sideroblastic anemia / MDS"),
    ("Megaloblasts",               "→ B12/Folate (if not treated)"),
    ("Fibrosis + teardrops",       "→ Myelofibrosis"),
    ("Blasts >20%",                "→ Acute leukemia (AML/ALL)"),
]
for i,(f,r) in enumerate(bm_finds):
    fy2 = y0+114+i*34
    draw.text((W//2+50, fy2), f"• {f}", font=font(21), fill=C["text"])
    draw.text((W//2+50+450, fy2), r, font=font(21,bold=True), fill="#4A148C")

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 11 – SEVERITY BOX
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 3720
rrect(draw, [40, y0, W-40, y0+100], radius=16, fill="#263238", outline="#37474F", width=2)
draw.text((W//2, y0+20), "SEVERITY CLASSIFICATION", font=font(26,bold=True), fill="#80CBC4", anchor="mm")
sev = [("MILD","10–12 g/dL","#4CAF50"),("MODERATE","8–10 g/dL","#FF9800"),
       ("SEVERE","6–8 g/dL","#F44336"),("LIFE-THREATENING","<6 g/dL","#B71C1C")]
sw = (W-80)//len(sev)
for i,(nm,rng,col) in enumerate(sev):
    sx = 40 + i*sw + sw//2
    draw.text((sx, y0+55), nm,  font=font(24,bold=True), fill=col,     anchor="mm")
    draw.text((sx, y0+82), rng, font=font(22),           fill="#ECEFF1",anchor="mm")
    if i<len(sev)-1:
        draw.line([(40+i*sw+sw, y0+30),(40+i*sw+sw, y0+95)], fill="#546E7A", width=2)

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 12 – ALGORITHM FLOWCHART (central visual)
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 3860
step_pill(draw, 40, y0, 620, 48, 11, "DIAGNOSTIC ALGORITHM", C["navy"])

# flowchart nodes
def flow_box(draw, cx, cy, w, h, text, fill, text_col="white", fsize=22, radius=14):
    rrect(draw, [cx-w//2, cy-h//2, cx+w//2, cy+h//2], radius=radius, fill=fill)
    lines = text.split("\n")
    lh = fsize+6
    ty = cy - (len(lines)-1)*lh//2
    for ln in lines:
        draw.text((cx, ty), ln, font=font(fsize, bold=True), fill=text_col, anchor="mm")
        ty += lh

def diamond(draw, cx, cy, w, h, text, fill, text_col="white"):
    pts = [(cx,cy-h//2),(cx+w//2,cy),(cx,cy+h//2),(cx-w//2,cy)]
    draw.polygon(pts, fill=fill)
    draw.polygon(pts, outline="#FFFFFF", width=2)
    draw.text((cx, cy), text, font=font(21,bold=True), fill=text_col, anchor="mm")

fa = y0+68
# Start
flow_box(draw, W//2, fa,    600, 50, "LOW HEMOGLOBIN (CBC)", C["navy"], fsize=24)
arrow(draw, W//2, fa+25, W//2, fa+80, color=C["arrow"], w=4)

# Smear + retic
flow_box(draw, W//2, fa+100, 700, 50, "Peripheral Blood Smear  +  Reticulocyte Count", C["teal"], fsize=22)
arrow(draw, W//2, fa+125, W//2, fa+175, color=C["arrow"], w=4)

# Diamond retic
diamond(draw, W//2, fa+210, 580, 90, "RETIC HIGH?", C["red"])

# YES left
arrow(draw, W//2-290, fa+210, W//2-560, fa+210, color=C["retic_hi"], w=4)
flow_box(draw, W//2-700, fa+210, 300, 60, "BLEEDING\nor\nHEMOLYSIS", C["retic_hi"], fsize=20)

# NO right
arrow(draw, W//2+290, fa+210, W//2+560, fa+210, color=C["retic_lo"], w=4)
flow_box(draw, W//2+700, fa+210, 300, 60, "UNDER-\nPRODUCTION", C["retic_lo"], fsize=20)

# down arrow to MCV
arrow(draw, W//2, fa+255, W//2, fa+310, color=C["arrow"], w=4)
diamond(draw, W//2, fa+345, 400, 80, "MCV?", C["purple"])

# micro
arrow(draw, W//2-200, fa+345, W//2-560, fa+345, color=C["micro_c"], w=4)
flow_box(draw, W//2-700, fa+345, 300, 60, "< 80 fL\nMICROCYTIC", C["micro_c"], fsize=20)
arrow(draw, W//2-700, fa+375, W//2-700, fa+430, color=C["micro_c"], w=3)
flow_box(draw, W//2-700, fa+465, 300, 60, "Ferritin · Fe ·\nTIBC · RDW\nHb Electro", C["micro_c"], fsize=18)

# normo
arrow(draw, W//2, fa+385, W//2, fa+430, color=C["normo_c"], w=4)
flow_box(draw, W//2, fa+465, 300, 60, "80–100 fL\nNORMOCYTIC", C["normo_c"], fsize=20)
arrow(draw, W//2, fa+495, W//2, fa+540, color=C["normo_c"], w=3)
flow_box(draw, W//2, fa+580, 300, 80, "eGFR · EPO\nTSH · SPEP\nBM biopsy?", C["normo_c"], fsize=18)

# macro
arrow(draw, W//2+200, fa+345, W//2+560, fa+345, color=C["macro_c"], w=4)
flow_box(draw, W//2+700, fa+345, 300, 60, "> 100 fL\nMACROCYTIC", C["macro_c"], fsize=20)
arrow(draw, W//2+700, fa+375, W//2+700, fa+430, color=C["macro_c"], w=3)
flow_box(draw, W//2+700, fa+465, 300, 60, "B12 · Folate\nTSH · LFTs\nBM if normal", C["macro_c"], fsize=18)

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 13 – KEY PEARLS
# ═══════════════════════════════════════════════════════════════════════════════
y0 = 4620
rrect(draw, [40, y0, W-40, y0+120], radius=16, fill="#1A237E", outline="#3F51B5", width=2)
draw.text((W//2, y0+22), "⚡  KEY DIAGNOSTIC PEARLS",
          font=font(30,bold=True), fill="#FFD54F", anchor="mm")
pearls = [
    "Retic count = Master branch point",
    "Ferritin <15 = Iron-depleted stores",
    "RDW HIGH + micro = IDA  |  RDW LOW + micro = Thalassemia",
    "Haptoglobin LOW = Hemolysis",
    "Hyperseg PMNs + oval macros = Megaloblastic",
    "MMA↑ (normal folate) = B12-specific",
    "Teardrops + nRBCs = Myelophthisic → Bone marrow biopsy",
    "≥75% anemia = Hypoproliferative",
]
px = 60; py = y0+52
for i,p in enumerate(pearls):
    col = "#FFD54F" if i%2==0 else "#80CBC4"
    draw.text((px, py), f"✦ {p}", font=font(21), fill=col)
    px += (W-80)//4
    if (i+1)%4==0: px=60; py+=36

# ═══════════════════════════════════════════════════════════════════════════════
# FOOTER
# ═══════════════════════════════════════════════════════════════════════════════
rrect(draw, [0,H-52,W,H], radius=0, fill=C["navy"])
draw.text((W//2, H-26),
          "Harrison's 22E (2025)  |  Robbins & Kumar Pathologic Basis of Disease  |  Goldman-Cecil Medicine  |  Tintinalli's Emergency Medicine",
          font=font(20), fill="#90CAF9", anchor="mm")

# ── Save ──────────────────────────────────────────────────────────────────────
out = "/home/daytona/workspace/anemia-note/Anemia_Diagnostic_Note.png"
img.save(out, "PNG", dpi=(200,200))
print(f"Saved → {out}")
print(f"Size: {W}x{H}px")