ls /home/daytona/workspace/ 2>/dev/null && echo "---" && ls /home/daytona/skills…

mkdir -p /home/daytona/workspace/anemia-pptx

~/anemia-pptx/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Anemia – A Comprehensive Overview";
pres.author = "Medical Education";

// ─── PALETTE ───────────────────────────────────────────────────────────────
const RED     = "C0392B";   // deep crimson – dominant accent
const DARK    = "1A1A2E";   // near-black navy
const MID     = "16213E";   // dark navy
const SLATE   = "0F3460";   // rich slate blue
const LIGHT   = "F5F6FA";   // off-white
const WHITE   = "FFFFFF";
const GOLD    = "E8A838";   // warm gold highlight
const SUBTLE  = "D4D6E0";   // muted grey text
const TEAL    = "1ABC9C";   // accent teal

// ─── HELPER: draw a coloured card ──────────────────────────────────────────
function card(slide, x, y, w, h, fill, text, fontSize=13, color=WHITE, bold=false) {
  slide.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: fill }, line: { color: fill }, rectRadius: 0.08 });
  slide.addText(text, { x, y, w, h, fontSize, color, bold, align: "center", valign: "middle", margin: 6 });
}

// ─── HELPER: section label ─────────────────────────────────────────────────
function sectionTag(slide, label) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: RED } });
  slide.addText(label.toUpperCase(), { x: 0.3, y: 0.14, w: 9, h: 0.3, fontSize: 8, color: RED, bold: true, charSpacing: 3 });
}

// ─── HELPER: dark slide background ────────────────────────────────────────
function darkBg(slide) {
  slide.background = { color: DARK };
}
function midBg(slide) {
  slide.background = { color: MID };
}
function lightBg(slide) {
  slide.background = { color: LIGHT };
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – Title
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);

  // Red accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: RED } });
  // Gold bar
  s.addShape(pres.ShapeType.rect, { x: 0.18, y: 0, w: 0.04, h: 5.625, fill: { color: GOLD } });

  s.addText("ANEMIA", { x: 0.5, y: 1.2, w: 8.5, h: 1.4, fontSize: 72, color: WHITE, bold: true, fontFace: "Calibri" });
  s.addText("A Comprehensive Overview for Medical Students", { x: 0.5, y: 2.7, w: 8.5, h: 0.6, fontSize: 20, color: GOLD, italic: true });

  s.addShape(pres.ShapeType.line, { x: 0.5, y: 3.4, w: 6, h: 0, line: { color: RED, width: 2 } });

  s.addText([
    { text: "Classification  •  Pathophysiology  •  Clinical Features  •  Diagnosis  •  Management", options: { color: SUBTLE, fontSize: 12 } }
  ], { x: 0.5, y: 3.6, w: 9, h: 0.4 });

  s.addText("Source: Robbins & Kumar Basic Pathology", { x: 0.5, y: 5.1, w: 9, h: 0.3, fontSize: 9, color: SUBTLE, italic: true });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – Agenda / Outline
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: RED } });

  s.addText("LECTURE OUTLINE", { x: 0.4, y: 0.25, w: 9, h: 0.5, fontSize: 28, color: GOLD, bold: true });

  const topics = [
    ["01", "Definition & Epidemiology"],
    ["02", "Classification by Mechanism"],
    ["03", "Anemia of Blood Loss"],
    ["04", "Hemolytic Anemias"],
    ["05", "Iron Deficiency Anemia"],
    ["06", "Anemia of Chronic Inflammation"],
    ["07", "Megaloblastic Anemias"],
    ["08", "Aplastic Anemia"],
    ["09", "Diagnosis & Laboratory Work-up"],
    ["10", "Management Principles"],
  ];

  topics.forEach(([num, title], i) => {
    const col = i < 5 ? 0 : 1;
    const row = i % 5;
    const x = col === 0 ? 0.4 : 5.2;
    const y = 1.0 + row * 0.82;
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.5, h: 0.5, fill: { color: RED } });
    s.addText(num, { x, y, w: 0.5, h: 0.5, fontSize: 14, color: WHITE, bold: true, align: "center", valign: "middle" });
    s.addText(title, { x: x + 0.6, y, w: 3.8, h: 0.5, fontSize: 13, color: WHITE, valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – Definition & Epidemiology
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionTag(s, "Definition & Epidemiology");

  s.addText("What Is Anemia?", { x: 0.4, y: 0.45, w: 9, h: 0.55, fontSize: 30, color: DARK, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 1.05, w: 4, h: 0, line: { color: RED, width: 2.5 } });

  // Definition box
  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 1.2, w: 9.2, h: 0.9, fill: { color: RED }, rectRadius: 0.1 });
  s.addText("A reduction in total circulating red cell mass — operationally defined as a hemoglobin below the lower limit of normal for age and sex — leading to diminished oxygen-carrying capacity of blood.", {
    x: 0.5, y: 1.2, w: 9, h: 0.9, fontSize: 14, color: WHITE, align: "center", valign: "middle", bold: false
  });

  // Key thresholds
  const thresh = [
    ["Adult Males", "Hb < 13.5 g/dL"],
    ["Adult Females", "Hb < 12 g/dL"],
    ["Children (6–59 mo)", "Hb < 11 g/dL"],
    ["Pregnant Women", "Hb < 11 g/dL"],
  ];
  thresh.forEach(([label, val], i) => {
    const x = 0.4 + i * 2.3;
    s.addShape(pres.ShapeType.roundRect, { x, y: 2.3, w: 2.1, h: 0.85, fill: { color: SLATE }, rectRadius: 0.08 });
    s.addText(label, { x, y: 2.3, w: 2.1, h: 0.42, fontSize: 11, color: GOLD, bold: true, align: "center", valign: "bottom", margin: 2 });
    s.addText(val, { x, y: 2.72, w: 2.1, h: 0.43, fontSize: 13, color: WHITE, bold: true, align: "center", valign: "top", margin: 2 });
  });

  // Epidemiology
  s.addText("Global Burden", { x: 0.4, y: 3.35, w: 9, h: 0.35, fontSize: 16, color: DARK, bold: true });
  const epi = [
    { text: "~2 billion people affected worldwide (WHO) — most common hematologic disorder globally.", options: { bullet: true, breakLine: true, fontSize: 12, color: DARK } },
    { text: "~10% of individuals in high-resource countries are anemic; up to 25–50% in low-resource settings.", options: { bullet: true, breakLine: true, fontSize: 12, color: DARK } },
    { text: "Most frequent single cause: iron deficiency anemia, especially in women of reproductive age and children.", options: { bullet: true, breakLine: true, fontSize: 12, color: DARK } },
    { text: "Significant morbidity: impaired cognition, reduced work capacity, adverse pregnancy outcomes.", options: { bullet: true, fontSize: 12, color: DARK } },
  ];
  s.addText(epi, { x: 0.4, y: 3.75, w: 9.2, h: 1.6 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – Classification
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midBg(s);
  sectionTag(s, "Classification");

  s.addText("Classification of Anemia", { x: 0.4, y: 0.25, w: 9, h: 0.55, fontSize: 28, color: WHITE, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 0.85, w: 3.5, h: 0, line: { color: GOLD, width: 2 } });

  s.addText("Two major frameworks:", { x: 0.4, y: 1.0, w: 9, h: 0.35, fontSize: 14, color: SUBTLE });

  // Morphological
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.4, w: 4.5, h: 3.8, fill: { color: SLATE }, rectRadius: 0.1 });
  s.addText("MORPHOLOGICAL (MCV-based)", { x: 0.4, y: 1.45, w: 4.3, h: 0.4, fontSize: 13, color: GOLD, bold: true });
  const morph = [
    ["Microcytic (MCV <80 fL)", "Iron deficiency, Thalassemia, Sideroblastic, ACD"],
    ["Normocytic (MCV 80–100)", "Acute blood loss, Hemolysis, ACD, Aplastic anemia, CKD"],
    ["Macrocytic (MCV >100)", "Vit B12/folate deficiency, Myelodysplasia, Liver disease, Drugs"],
  ];
  morph.forEach(([type, causes], i) => {
    const y = 1.95 + i * 0.95;
    s.addShape(pres.ShapeType.roundRect, { x: 0.45, y, w: 4.1, h: 0.8, fill: { color: DARK }, rectRadius: 0.06 });
    s.addText(type, { x: 0.55, y, w: 3.9, h: 0.35, fontSize: 11, color: RED, bold: true, valign: "bottom", margin: 2 });
    s.addText(causes, { x: 0.55, y: y + 0.35, w: 3.9, h: 0.45, fontSize: 9.5, color: SUBTLE, valign: "top", margin: 2 });
  });

  // Pathophysiological
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.4, w: 4.6, h: 3.8, fill: { color: SLATE }, rectRadius: 0.1 });
  s.addText("PATHOPHYSIOLOGICAL (Mechanism)", { x: 5.2, y: 1.45, w: 4.4, h: 0.4, fontSize: 13, color: GOLD, bold: true });
  const patho = [
    ["Blood Loss", "Acute hemorrhage → normocytic\nChronic loss → iron deficiency"],
    ["Hemolytic", "Intrinsic (membrane/enzyme/Hb defects)\nExtrinsic (immune, microangiopathic)"],
    ["Diminished\nErythropoiesis", "Iron / B12 / folate deficiency\nAplastic anemia, ACD, renal anemia"],
  ];
  patho.forEach(([type, causes], i) => {
    const y = 1.95 + i * 0.95;
    s.addShape(pres.ShapeType.roundRect, { x: 5.25, y, w: 4.3, h: 0.8, fill: { color: DARK }, rectRadius: 0.06 });
    s.addText(type, { x: 5.35, y, w: 1.1, h: 0.8, fontSize: 11, color: RED, bold: true, valign: "middle", margin: 2 });
    s.addText(causes, { x: 6.45, y, w: 3.0, h: 0.8, fontSize: 9.5, color: SUBTLE, valign: "middle", margin: 2 });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – Anemia of Blood Loss
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionTag(s, "Anemia of Blood Loss");

  s.addText("Anemia of Blood Loss", { x: 0.4, y: 0.45, w: 9, h: 0.55, fontSize: 28, color: DARK, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 1.05, w: 4.5, h: 0, line: { color: RED, width: 2.5 } });

  // Acute column
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.2, w: 4.4, h: 4.1, fill: { color: DARK }, rectRadius: 0.12 });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 4.4, h: 0.5, fill: { color: RED } });
  s.addText("ACUTE HEMORRHAGE", { x: 0.35, y: 1.2, w: 4.3, h: 0.5, fontSize: 14, color: WHITE, bold: true, align: "center", valign: "middle" });
  const acute = [
    "Immediate threat: hypovolemia, shock (if blood loss >20%)",
    "RBCs and plasma lost proportionally — Hb may be normal initially",
    "After fluid resuscitation (2–3 days): hemodilution reveals full extent of anemia",
    "Morphology: normocytic, normochromic",
    "Recovery: EPO ↑ → reticulocytosis (lag 5–7 days)",
    "Serum iron/ferritin: initially normal; depleted only with chronic bleeding",
  ];
  s.addText(acute.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < acute.length - 1, fontSize: 11, color: LIGHT } })), { x: 0.5, y: 1.8, w: 4.0, h: 3.3 });

  // Chronic column
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.2, w: 4.6, h: 4.1, fill: { color: DARK }, rectRadius: 0.12 });
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.2, w: 4.6, h: 0.5, fill: { color: SLATE } });
  s.addText("CHRONIC BLOOD LOSS", { x: 5.15, y: 1.2, w: 4.5, h: 0.5, fontSize: 14, color: WHITE, bold: true, align: "center", valign: "middle" });
  const chronic = [
    "Gradual iron store depletion → microcytic hypochromic anemia",
    "Common causes: GI bleeding (ulcers, cancer, hookworm), menorrhagia",
    "Iron is essential for Hb synthesis; its loss leads to underproduction anemia",
    "Symptoms appear slowly: fatigue, pallor, exertional dyspnea",
    "Lab: ↓ ferritin, ↓ serum iron, ↑ TIBC",
    "Treatment: identify & stop source; oral iron supplementation",
  ];
  s.addText(chronic.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < chronic.length - 1, fontSize: 11, color: LIGHT } })), { x: 5.25, y: 1.8, w: 4.2, h: 3.3 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 6 – Hemolytic Anemias Overview
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midBg(s);
  sectionTag(s, "Hemolytic Anemias");

  s.addText("Hemolytic Anemias – Overview", { x: 0.4, y: 0.25, w: 9, h: 0.55, fontSize: 27, color: WHITE, bold: true });

  // Intro
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.9, w: 9.4, h: 0.7, fill: { color: RED }, rectRadius: 0.08 });
  s.addText("Common feature: accelerated red cell destruction (RBC lifespan <120 days) → EPO release → marrow erythroid hyperplasia + peripheral reticulocytosis.", {
    x: 0.4, y: 0.9, w: 9.2, h: 0.7, fontSize: 12, color: WHITE, valign: "middle", align: "center"
  });

  // Extravascular vs Intravascular
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.72, w: 4.55, h: 3.65, fill: { color: SLATE }, rectRadius: 0.1 });
  s.addText("EXTRAVASCULAR HEMOLYSIS", { x: 0.4, y: 1.76, w: 4.35, h: 0.4, fontSize: 12, color: GOLD, bold: true });
  const ev = [
    "RBCs destroyed by splenic macrophages",
    "Cause: reduced deformability (e.g., spherocytes, sickle cells)",
    "Features:",
    "  • Hyperbilirubinemia & jaundice",
    "  • Splenomegaly (work hyperplasia)",
    "  • Pigment gallstones (bilirubin-rich) if chronic",
    "Examples: Hereditary spherocytosis, Sickle cell disease, Thalassemia, G6PD deficiency",
  ];
  s.addText(ev.map((t, i) => ({ text: t, options: { bullet: !t.startsWith("  "), breakLine: i < ev.length - 1, fontSize: 11, color: LIGHT } })), { x: 0.45, y: 2.2, w: 4.3, h: 3.0 });

  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.72, w: 4.65, h: 3.65, fill: { color: SLATE }, rectRadius: 0.1 });
  s.addText("INTRAVASCULAR HEMOLYSIS", { x: 5.2, y: 1.76, w: 4.45, h: 0.4, fontSize: 12, color: GOLD, bold: true });
  const iv = [
    "RBCs lyse within circulation",
    "Causes: mechanical forces, complement, toxins",
    "Features:",
    "  • Hemoglobinemia (pink/red plasma)",
    "  • Hemoglobinuria (dark urine)",
    "  • Hemosiderinuria (iron in urine)",
    "  • Chronic: secondary iron deficiency",
    "Examples: PNH, TTP/HUS, mechanical heart valves",
  ];
  s.addText(iv.map((t, i) => ({ text: t, options: { bullet: !t.startsWith("  "), breakLine: i < iv.length - 1, fontSize: 11, color: LIGHT } })), { x: 5.25, y: 2.2, w: 4.4, h: 3.0 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 7 – Hereditary Spherocytosis & Sickle Cell
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionTag(s, "Hemolytic Anemias – Intrinsic Defects");

  s.addText("Hereditary Spherocytosis  &  Sickle Cell Anemia", { x: 0.3, y: 0.45, w: 9.4, h: 0.55, fontSize: 22, color: DARK, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 1.05, w: 7, h: 0, line: { color: RED, width: 2 } });

  // Spherocytosis
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.15, w: 4.6, h: 4.2, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("HEREDITARY SPHEROCYTOSIS", { x: 0.4, y: 1.18, w: 4.4, h: 0.45, fontSize: 12, color: RED, bold: true });
  const hs = [
    { label: "Genetics:", val: "AD (mostly); AR (severe form)" },
    { label: "Defect:", val: "Mutations in spectrin, ankyrin, band 3, or band 4.1 → weakened membrane skeleton → membrane vesicle shedding → spherocytes" },
    { label: "Pathophysiology:", val: "Spherocytes lack deformability → trapped in splenic cords → phagocytosed" },
    { label: "Clinical:", val: "Anemia, splenomegaly, jaundice; cholelithiasis in 40–50%; aplastic crises with parvovirus B19" },
    { label: "Lab:", val: "↑ osmotic fragility; spherocytes on smear (dark, no central pallor)" },
    { label: "Treatment:", val: "Splenectomy corrects anemia (spherocytes persist but not destroyed)" },
  ];
  let yy = 1.68;
  hs.forEach(({ label, val }) => {
    s.addText([
      { text: label + " ", options: { bold: true, color: GOLD, fontSize: 10.5 } },
      { text: val, options: { color: LIGHT, fontSize: 10.5 } },
    ], { x: 0.45, y: yy, w: 4.35, h: 0.55 });
    yy += 0.55;
  });

  // Sickle Cell
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.15, w: 4.65, h: 4.2, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("SICKLE CELL ANEMIA", { x: 5.2, y: 1.18, w: 4.45, h: 0.45, fontSize: 12, color: RED, bold: true });
  const sca = [
    { label: "Genetics:", val: "AR; single AA substitution — Glu→Val at β-globin position 6 → HbS" },
    { label: "Pathophysiology:", val: "Deoxygenated HbS polymerizes → sickled cells → vaso-occlusion + hemolysis; irreversible sickling with repeated episodes" },
    { label: "Factors promoting sickling:", val: "↑ HbS concentration, ↓ O₂ tension, acidosis, dehydration" },
    { label: "Clinical:", val: "Vaso-occlusive crises (bone pain, acute chest syndrome, stroke), hemolytic anemia, autosplenectomy, hand-foot syndrome in infancy" },
    { label: "Lab:", val: "HbS on electrophoresis; sickled cells + target cells on smear; Hb 6–9 g/dL" },
    { label: "Treatment:", val: "Hydroxyurea (↑ HbF), transfusions, bone marrow transplant; penicillin prophylaxis in children" },
  ];
  let yy2 = 1.68;
  sca.forEach(({ label, val }) => {
    s.addText([
      { text: label + " ", options: { bold: true, color: GOLD, fontSize: 10.5 } },
      { text: val, options: { color: LIGHT, fontSize: 10.5 } },
    ], { x: 5.25, y: yy2, w: 4.4, h: 0.55 });
    yy2 += 0.55;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 8 – Thalassemias
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midBg(s);
  sectionTag(s, "Hemolytic Anemias – Thalassemia");

  s.addText("Thalassemias", { x: 0.4, y: 0.25, w: 9, h: 0.55, fontSize: 30, color: WHITE, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 0.85, w: 3, h: 0, line: { color: GOLD, width: 2 } });

  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.0, w: 9.4, h: 0.65, fill: { color: SLATE }, rectRadius: 0.08 });
  s.addText("Inherited disorders of haemoglobin synthesis — reduced or absent production of α- or β-globin chains → imbalanced chain accumulation → ineffective erythropoiesis + hemolysis.", {
    x: 0.4, y: 1.0, w: 9.2, h: 0.65, fontSize: 12, color: LIGHT, valign: "middle"
  });

  // β-thalassemia
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.8, w: 4.6, h: 3.55, fill: { color: DARK }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.8, w: 4.6, h: 0.45, fill: { color: RED } });
  s.addText("β-THALASSEMIA", { x: 0.35, y: 1.8, w: 4.5, h: 0.45, fontSize: 13, color: WHITE, bold: true, align: "center", valign: "middle" });
  const bt = [
    "Mutations in β-globin gene on Chr 11",
    "Excess α-chains precipitate → damage RBC membrane → ineffective erythropoiesis",
    "Minor (trait): β/β⁺ — usually asymptomatic, mild microcytosis",
    "Intermedia: moderate anemia, some transfusion need",
    "Major (Cooley's): β°/β° — severe, transfusion-dependent from infancy",
    "Marrow expansion → crew-cut skull, maxillary hypertrophy (chipmunk face)",
    "Treatment: regular transfusions + iron chelation; BMT curative",
  ];
  s.addText(bt.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < bt.length - 1, fontSize: 10.5, color: LIGHT } })), { x: 0.45, y: 2.33, w: 4.35, h: 2.9 });

  // α-thalassemia
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.8, w: 4.65, h: 3.55, fill: { color: DARK }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.8, w: 4.65, h: 0.45, fill: { color: SLATE } });
  s.addText("α-THALASSEMIA", { x: 5.15, y: 1.8, w: 4.55, h: 0.45, fontSize: 13, color: WHITE, bold: true, align: "center", valign: "middle" });
  const at = [
    "Deletion/mutation of α-globin genes on Chr 16 (4 gene loci total)",
    "1 gene deleted — silent carrier; 2 deleted — α-thal trait (mild)",
    "3 deleted — HbH disease (β-tetramers): moderate hemolytic anemia",
    "4 deleted — Hb Barts (γ-tetramers): hydrops fetalis; incompatible with life",
    "Excess β-chains form unstable tetramers that precipitate within red cells",
    "Most severe forms are common in Southeast Asia",
  ];
  s.addText(at.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < at.length - 1, fontSize: 10.5, color: LIGHT } })), { x: 5.25, y: 2.33, w: 4.4, h: 2.9 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 9 – G6PD & PNH
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sectionTag(s, "Hemolytic Anemias – Enzyme & Complement Defects");

  s.addText("G6PD Deficiency  &  Paroxysmal Nocturnal Hemoglobinuria", { x: 0.3, y: 0.45, w: 9.4, h: 0.55, fontSize: 20, color: DARK, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 1.05, w: 8, h: 0, line: { color: RED, width: 2 } });

  // G6PD
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.15, w: 4.6, h: 4.2, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("G6PD DEFICIENCY", { x: 0.4, y: 1.18, w: 4.4, h: 0.4, fontSize: 13, color: GOLD, bold: true });
  const g6 = [
    { label: "Inheritance:", val: "X-linked recessive (>400 variants)" },
    { label: "Mechanism:", val: "↓ G6PD → ↓ GSH → oxidant stress → Heinz bodies → bite cells → intravascular hemolysis" },
    { label: "Triggers:", val: "Drugs (primaquine, sulfa, nitrofurantoin), infections, fava beans" },
    { label: "G6PD A-:", val: "African variant; only old RBCs affected; hemolysis self-limited" },
    { label: "G6PD Mediterranean:", val: "More severe; found in Middle East" },
    { label: "Lab:", val: "Heinz bodies (supravital stain), bite cells on smear; ↓ G6PD enzyme assay" },
    { label: "Treatment:", val: "Avoid triggers; supportive; transfusion if severe" },
  ];
  let y6 = 1.65;
  g6.forEach(({ label, val }) => {
    s.addText([
      { text: label + " ", options: { bold: true, color: GOLD, fontSize: 10.5 } },
      { text: val, options: { color: LIGHT, fontSize: 10.5 } },
    ], { x: 0.45, y: y6, w: 4.35, h: 0.52 });
    y6 += 0.52;
  });

  // PNH
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.15, w: 4.65, h: 4.2, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("PAROXYSMAL NOCTURNAL\nHEMOGLOBINURIA (PNH)", { x: 5.2, y: 1.18, w: 4.45, h: 0.6, fontSize: 12, color: GOLD, bold: true });
  const pnh = [
    { label: "Mutation:", val: "Somatic mutation in PIG-A gene (X-linked) → deficient GPI-anchored proteins (CD55, CD59)" },
    { label: "Mechanism:", val: "Loss of CD55 (DAF) and CD59 → uncontrolled complement activation → intravascular hemolysis" },
    { label: "Clinical triad:", val: "Intravascular hemolysis, thrombosis (unusual sites: hepatic, portal, sagittal sinus), cytopenias" },
    { label: "Classic finding:", val: "Dark morning urine (hemoglobinuria concentrates overnight)" },
    { label: "Lab:", val: "Flow cytometry — ↓ CD55/CD59 on RBCs; Ham test (historical)" },
    { label: "Treatment:", val: "Eculizumab (anti-C5 antibody) blocks complement; allogenic BMT curative" },
  ];
  let yp = 1.82;
  pnh.forEach(({ label, val }) => {
    s.addText([
      { text: label + " ", options: { bold: true, color: GOLD, fontSize: 10.5 } },
      { text: val, options: { color: LIGHT, fontSize: 10.5 } },
    ], { x: 5.25, y: yp, w: 4.4, h: 0.55 });
    yp += 0.55;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 10 – Iron Deficiency Anemia
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: "F8F9FB" };
  sectionTag(s, "Anemia of Diminished Erythropoiesis");

  s.addText("Iron Deficiency Anemia", { x: 0.4, y: 0.45, w: 9, h: 0.55, fontSize: 30, color: DARK, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 1.05, w: 5, h: 0, line: { color: RED, width: 2.5 } });

  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.15, w: 9.4, h: 0.62, fill: { color: RED }, rectRadius: 0.08 });
  s.addText("Most common nutritional deficiency worldwide. ~10% of individuals in high-resource and 25–50% in low-resource countries are anemic, with iron deficiency as the leading cause.", {
    x: 0.4, y: 1.15, w: 9.2, h: 0.62, fontSize: 12, color: WHITE, valign: "middle"
  });

  // Two columns
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.9, w: 4.6, h: 3.45, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("PATHOPHYSIOLOGY & CAUSES", { x: 0.4, y: 1.93, w: 4.4, h: 0.38, fontSize: 11, color: GOLD, bold: true });
  const ipath = [
    "Normal body iron: 2.5 g (F) – 3.5 g (M); 80% in Hb/myoglobin",
    "Storage pool: ferritin & hemosiderin in macrophages (liver, spleen, marrow)",
    "Normal serum ferritin reflects stores; transferrin saturation ~33%",
    "Iron loss: 1–2 mg/day via epithelial shedding",
    "Causes of deficiency:",
    "  • Inadequate intake (infants, vegetarians, elderly)",
    "  • Increased demand (pregnancy, growth)",
    "  • Chronic blood loss (GI bleed, menorrhagia, hookworm)",
    "  • Malabsorption (celiac disease, gastrectomy)",
  ];
  s.addText(ipath.map((t, i) => ({ text: t, options: { bullet: !t.startsWith("  "), breakLine: i < ipath.length - 1, fontSize: 10, color: LIGHT } })), { x: 0.45, y: 2.35, w: 4.35, h: 2.9 });

  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.9, w: 4.65, h: 3.45, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("CLINICAL & LABORATORY", { x: 5.2, y: 1.93, w: 4.45, h: 0.38, fontSize: 11, color: GOLD, bold: true });
  const iclin = [
    "Stages: iron store depletion → latent deficiency → overt anemia",
    "Symptoms: fatigue, pallor, exertional dyspnea, palpitations",
    "Specific signs: koilonychia (spoon nails), glossitis, angular stomatitis, pica",
    "Plummer-Vinson syndrome: IDA + esophageal webs + dysphagia",
    "Lab findings:",
    "  • ↓ Hb, ↓ MCV (microcytic), ↓ MCH (hypochromic)",
    "  • ↓ Serum ferritin (most sensitive early marker)",
    "  • ↓ Serum iron, ↑ TIBC",
    "  • ↑ RDW (anisocytosis)",
    "Smear: pencil cells, target cells, poikilocytosis",
    "Treatment: oral ferrous sulfate 325 mg TDS; identify cause",
  ];
  s.addText(iclin.map((t, i) => ({ text: t, options: { bullet: !t.startsWith("  "), breakLine: i < iclin.length - 1, fontSize: 10, color: LIGHT } })), { x: 5.25, y: 2.35, w: 4.4, h: 2.9 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 11 – Anemia of Chronic Inflammation (ACI)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midBg(s);
  sectionTag(s, "Anemia of Diminished Erythropoiesis");

  s.addText("Anemia of Chronic Inflammation (ACI)", { x: 0.4, y: 0.25, w: 9, h: 0.55, fontSize: 26, color: WHITE, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 0.85, w: 5.5, h: 0, line: { color: GOLD, width: 2 } });

  // Mechanism flow
  s.addText("Pathophysiology", { x: 0.4, y: 0.98, w: 9, h: 0.35, fontSize: 15, color: GOLD, bold: true });
  const steps = [
    "Chronic inflammation\n(infection, autoimmune,\nmalignancy, CKD)",
    "↑ IL-6 / cytokines\n→ ↑ Hepcidin from liver",
    "Hepcidin ↓ ferroportin\n→ iron sequestered in\nmacrophages",
    "↓ Iron availability\nfor erythropoiesis\n+ ↓ EPO response",
    "Normocytic-normochromic\nanemia (may become\nmicrocytic over time)",
  ];
  const colors5 = [SLATE, RED, RED, SLATE, DARK];
  steps.forEach((t, i) => {
    const x = 0.3 + i * 1.9;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.38, w: 1.7, h: 1.0, fill: { color: colors5[i] }, rectRadius: 0.08 });
    s.addText(t, { x, y: 1.38, w: 1.7, h: 1.0, fontSize: 9, color: WHITE, align: "center", valign: "middle" });
    if (i < 4) {
      s.addText("→", { x: x + 1.7, y: 1.6, w: 0.2, h: 0.5, fontSize: 18, color: GOLD, bold: true, align: "center", valign: "middle" });
    }
  });

  // Key features
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 2.55, w: 4.5, h: 2.8, fill: { color: SLATE }, rectRadius: 0.1 });
  s.addText("KEY FEATURES & LABS", { x: 0.4, y: 2.6, w: 4.3, h: 0.35, fontSize: 12, color: GOLD, bold: true });
  const kf = [
    "Usually mild to moderate (Hb 7–12 g/dL)",
    "Normocytic-normochromic (can be mildly microcytic)",
    "↓ Serum iron AND ↓ TIBC (both low — key differentiator from IDA)",
    "↑ Ferritin (acute phase reactant — iron is trapped, not depleted)",
    "↑ Serum hepcidin",
    "Low reticulocyte count",
    "Bone marrow shows adequate iron stores",
  ];
  s.addText(kf.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < kf.length - 1, fontSize: 11, color: LIGHT } })), { x: 0.45, y: 3.0, w: 4.3, h: 2.2 });

  // Distinction table vs IDA
  s.addShape(pres.ShapeType.roundRect, { x: 5.0, y: 2.55, w: 4.7, h: 2.8, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("ACI vs IRON DEFICIENCY", { x: 5.1, y: 2.6, w: 4.5, h: 0.35, fontSize: 12, color: GOLD, bold: true });
  const headers = ["Lab", "IDA", "ACI"];
  const rows = [
    ["Serum Iron", "↓", "↓"],
    ["TIBC", "↑", "↓"],
    ["Ferritin", "↓", "↑"],
    ["Transferrin sat.", "↓", "↓"],
    ["Hepcidin", "↓", "↑"],
    ["BM iron stores", "Absent", "Present"],
  ];
  // Header row
  headers.forEach((h, ci) => {
    const cols = [5.1, 6.7, 8.3];
    s.addShape(pres.ShapeType.rect, { x: cols[ci], y: 3.0, w: ci === 0 ? 1.5 : 1.5, h: 0.3, fill: { color: RED } });
    s.addText(h, { x: cols[ci], y: 3.0, w: 1.5, h: 0.3, fontSize: 10, color: WHITE, bold: true, align: "center", valign: "middle" });
  });
  rows.forEach((row, ri) => {
    const cols = [5.1, 6.7, 8.3];
    row.forEach((cell, ci) => {
      const fill = ri % 2 === 0 ? SLATE : MID;
      s.addShape(pres.ShapeType.rect, { x: cols[ci], y: 3.35 + ri * 0.3, w: 1.5, h: 0.3, fill: { color: fill } });
      s.addText(cell, { x: cols[ci], y: 3.35 + ri * 0.3, w: 1.5, h: 0.3, fontSize: 9.5, color: LIGHT, align: "center", valign: "middle" });
    });
  });

  // Treatment
  s.addShape(pres.ShapeType.roundRect, { x: 5.0, y: 5.0, w: 4.7, h: 0.45, fill: { color: TEAL }, rectRadius: 0.06 });
  s.addText("Treatment: Treat underlying disease; EPO-stimulating agents in CKD/cancer; IV iron if severe.", {
    x: 5.05, y: 5.0, w: 4.6, h: 0.45, fontSize: 9.5, color: WHITE, valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 12 – Megaloblastic Anemias
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: "F8F9FB" };
  sectionTag(s, "Anemia of Diminished Erythropoiesis");

  s.addText("Megaloblastic Anemias", { x: 0.4, y: 0.45, w: 9, h: 0.55, fontSize: 30, color: DARK, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 1.05, w: 4.5, h: 0, line: { color: RED, width: 2.5 } });

  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.15, w: 9.4, h: 0.6, fill: { color: SLATE }, rectRadius: 0.08 });
  s.addText("Deficiency of B12 or folate → impaired dTMP synthesis → blocked DNA replication → megaloblastic changes in all rapidly dividing cells (marrow, GI epithelium).", {
    x: 0.4, y: 1.15, w: 9.2, h: 0.6, fontSize: 12, color: LIGHT, valign: "middle"
  });

  // B12 deficiency
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.88, w: 4.55, h: 3.5, fill: { color: DARK }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.88, w: 4.55, h: 0.45, fill: { color: RED } });
  s.addText("VITAMIN B12 DEFICIENCY", { x: 0.35, y: 1.88, w: 4.45, h: 0.45, fontSize: 13, color: WHITE, bold: true, align: "center", valign: "middle" });
  const b12 = [
    "Rarely dietary (except strict vegans); usually absorption problem",
    "Requires intrinsic factor (IF) from gastric parietal cells for ileal absorption",
    "Pernicious anemia: autoimmune — antibodies against IF or parietal cells",
    "Other causes: gastrectomy, ileal resection, Crohn's disease, fish tapeworm",
    "Symptoms: fatigue + NEUROLOGICAL — subacute combined degeneration of spinal cord (posterior + lateral column demyelination), peripheral neuropathy, cognitive changes",
    "Lab: macrocytic anemia, hypersegmented neutrophils (>5 lobes), ↓ B12, ↑ MMA, ↑ homocysteine",
    "Treatment: IM hydroxocobalamin or cyanocobalamin",
  ];
  s.addText(b12.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < b12.length - 1, fontSize: 10, color: LIGHT } })), { x: 0.45, y: 2.38, w: 4.3, h: 2.9 });

  // Folate deficiency
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.88, w: 4.65, h: 3.5, fill: { color: DARK }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.88, w: 4.65, h: 0.45, fill: { color: SLATE } });
  s.addText("FOLATE DEFICIENCY", { x: 5.15, y: 1.88, w: 4.55, h: 0.45, fontSize: 13, color: WHITE, bold: true, align: "center", valign: "middle" });
  const folate = [
    "Folate present in all foods; destroyed by cooking (10–15 min)",
    "Common causes: poor diet, increased demand (pregnancy, hemolytic anemia), malabsorption (celiac), drugs (methotrexate, phenytoin, alcohol)",
    "Role: tetrahydrofolate is required for dTMP synthesis (via DHFR)",
    "Clinical: megaloblastic anemia + GI symptoms (glossitis, sore tongue); NO neurological features",
    "Lab: macrocytic anemia, ↓ serum & RBC folate, ↑ homocysteine; MMA is NORMAL (differentiates from B12)",
    "Treatment: oral folic acid 5 mg/day; supplement in pregnancy to prevent NTDs",
  ];
  s.addText(folate.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < folate.length - 1, fontSize: 10, color: LIGHT } })), { x: 5.25, y: 2.38, w: 4.4, h: 2.9 });

  // Key differentiator
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 5.47, w: 9.4, h: 0.45, fill: { color: GOLD }, rectRadius: 0.06 });
  s.addText("⚠  KEY DIFFERENTIATOR: Neurological signs (subacute combined degeneration) = B12 deficiency. Folate deficiency does NOT cause neurological abnormalities.", {
    x: 0.4, y: 5.47, w: 9.2, h: 0.45, fontSize: 11, color: DARK, bold: true, valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 13 – Aplastic Anemia
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  midBg(s);
  sectionTag(s, "Aplastic Anemia");

  s.addText("Aplastic Anemia", { x: 0.4, y: 0.25, w: 9, h: 0.55, fontSize: 32, color: WHITE, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 0.85, w: 3.5, h: 0, line: { color: GOLD, width: 2 } });

  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.98, w: 9.4, h: 0.6, fill: { color: RED }, rectRadius: 0.08 });
  s.addText("Failure of hematopoiesis due to destruction or suppression of multipotent myeloid stem cells → pancytopenia (anemia + neutropenia + thrombocytopenia) with a hypocellular bone marrow.", {
    x: 0.4, y: 0.98, w: 9.2, h: 0.6, fontSize: 12, color: WHITE, valign: "middle"
  });

  // Etiology
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.7, w: 4.55, h: 3.65, fill: { color: SLATE }, rectRadius: 0.1 });
  s.addText("ETIOLOGY", { x: 0.4, y: 1.73, w: 4.35, h: 0.38, fontSize: 13, color: GOLD, bold: true });
  const etio = [
    { h: "Idiopathic (~65%)", b: "Most common; likely immune-mediated T-cell destruction of stem cells" },
    { h: "Secondary — Drugs:", b: "Chloramphenicol, sulfonamides, antiepileptics, NSAIDs, cytotoxics" },
    { h: "Viral infections:", b: "EBV, HIV, hepatitis (seronegative hepatitis), parvovirus B19" },
    { h: "Radiation exposure", b: "Dose-dependent suppression" },
    { h: "Constitutional:", b: "Fanconi anemia (AR); Dyskeratosis congenita" },
  ];
  let yet = 2.18;
  etio.forEach(({ h, b }) => {
    s.addText([
      { text: h + ": ", options: { bold: true, color: GOLD, fontSize: 10.5 } },
      { text: b, options: { color: LIGHT, fontSize: 10.5 } },
    ], { x: 0.45, y: yet, w: 4.3, h: 0.62 });
    yet += 0.62;
  });

  // Clinical + Treatment
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.7, w: 4.65, h: 3.65, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("CLINICAL & MANAGEMENT", { x: 5.2, y: 1.73, w: 4.45, h: 0.38, fontSize: 13, color: GOLD, bold: true });
  const aclin = [
    "Symptoms from pancytopenia:",
    "  • Anemia → fatigue, pallor",
    "  • Neutropenia → infections (oral ulcers, pneumonia)",
    "  • Thrombocytopenia → bleeding (purpura, epistaxis)",
    "Bone marrow biopsy: hypocellular marrow replaced by fat cells (diagnostic)",
    "Severity classification:",
    "  • Severe: ANC <500/μL; platelets <20,000; retics <20,000",
    "  • Very severe: ANC <200/μL",
    "Treatment:",
    "  • <40 yrs + HLA-matched sibling: Allogeneic BMT (curative)",
    "  • Others: Immunosuppression — anti-thymocyte globulin (ATG) + cyclosporine",
    "  • Eltrombopag (TPO agonist) added to IST improves response",
    "  • Supportive: transfusions, G-CSF, infection prevention",
  ];
  s.addText(aclin.map((t, i) => ({ text: t, options: { bullet: !t.startsWith("  "), breakLine: i < aclin.length - 1, fontSize: 10, color: LIGHT } })), { x: 5.25, y: 2.18, w: 4.4, h: 3.1 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 14 – Autoimmune & Microangiopathic Hemolytic Anemia
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: "F8F9FB" };
  sectionTag(s, "Hemolytic Anemias – Extrinsic Defects");

  s.addText("Autoimmune & Microangiopathic Hemolytic Anemias", { x: 0.3, y: 0.45, w: 9.4, h: 0.55, fontSize: 21, color: DARK, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 1.05, w: 8, h: 0, line: { color: RED, width: 2 } });

  // AIHA
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.15, w: 4.6, h: 4.2, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("AUTOIMMUNE HEMOLYTIC\nANEMIA (AIHA)", { x: 0.4, y: 1.18, w: 4.4, h: 0.55, fontSize: 12, color: GOLD, bold: true });
  const aiha = [
    { label: "Mechanism:", val: "Auto-antibodies coat RBCs → Fc receptor-mediated splenic phagocytosis (extravascular)" },
    { label: "Warm AIHA (IgG):", val: "Most common (70–80%); Abs active at 37°C; associated with SLE, CLL, drugs (methyldopa, penicillin)" },
    { label: "Cold AIHA (IgM):", val: "Abs maximally active <30°C; complement activation; linked to Mycoplasma, EBV, lymphoma" },
    { label: "Lab:", val: "Positive direct Coombs (DAT); spherocytes; ↑ bilirubin; ↑ LDH; ↓ haptoglobin" },
    { label: "Treatment:", val: "Warm: steroids, rituximab, splenectomy. Cold: avoid cold, rituximab" },
  ];
  let ya = 1.78;
  aiha.forEach(({ label, val }) => {
    s.addText([
      { text: label + " ", options: { bold: true, color: GOLD, fontSize: 10.5 } },
      { text: val, options: { color: LIGHT, fontSize: 10.5 } },
    ], { x: 0.45, y: ya, w: 4.35, h: 0.6 });
    ya += 0.6;
  });

  // MAHA
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.15, w: 4.65, h: 4.2, fill: { color: DARK }, rectRadius: 0.1 });
  s.addText("MICROANGIOPATHIC\nHEMOLYTIC ANEMIA (MAHA)", { x: 5.2, y: 1.18, w: 4.45, h: 0.55, fontSize: 12, color: GOLD, bold: true });
  const maha = [
    { label: "Mechanism:", val: "Fibrin strands or mechanical forces in vessels shear RBCs → schistocytes (helmet cells)" },
    { label: "Causes:", val: "TTP (ADAMTS13 deficiency), HUS (E. coli O157:H7), DIC, pre-eclampsia/HELLP, malignant HTN, prosthetic heart valves" },
    { label: "Lab:", val: "Schistocytes on smear (pathognomonic); intravascular hemolysis labs (↑ LDH, ↓ haptoglobin, hemoglobinuria); thrombocytopenia often co-present" },
    { label: "TTP pentad:", val: "MAHA + thrombocytopenia + neurological symptoms + fever + renal failure" },
    { label: "Treatment:", val: "TTP: plasma exchange + steroids. HUS: supportive. DIC: treat cause" },
  ];
  let ym = 1.78;
  maha.forEach(({ label, val }) => {
    s.addText([
      { text: label + " ", options: { bold: true, color: GOLD, fontSize: 10.5 } },
      { text: val, options: { color: LIGHT, fontSize: 10.5 } },
    ], { x: 5.25, y: ym, w: 4.4, h: 0.6 });
    ym += 0.6;
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 15 – Diagnostic Work-up
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sectionTag(s, "Diagnosis");

  s.addText("Diagnostic Approach to Anemia", { x: 0.4, y: 0.25, w: 9, h: 0.55, fontSize: 27, color: WHITE, bold: true });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 0.85, w: 5.5, h: 0, line: { color: GOLD, width: 2 } });

  // Step boxes
  const steps2 = [
    { num: "1", title: "History & Exam", pts: ["Duration, onset, rate\nDiet, meds, family Hx\nMenstruation, GI bleeding\nPallor, jaundice, splenomegaly\nNeurological signs (B12?)"] },
    { num: "2", title: "CBC + Indices", pts: ["Hb/Hct, RBC count\nMCV → micro/normo/macro\nMCH, MCHC\nRDW (anisocytosis)\nReticulocyte count"] },
    { num: "3", title: "Peripheral Smear", pts: ["Spherocytes → HS/AIHA\nSickle cells → SCA\nTarget cells → thal/IDA\nSchistocytes → MAHA\nHyperseg neutrophils → megaloblastic"] },
    { num: "4", title: "Targeted Tests", pts: ["Iron studies (ferritin, TIBC)\nB12, folate levels\nMMA, homocysteine\nDirect Coombs (DAT)\nHb electrophoresis\nFlow cytometry (CD55/59 for PNH)\nBone marrow biopsy if needed"] },
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 16 – Management Principles
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    { icon: "1.", title: "Treat the Underlying Cause", body: "Most important step. GI source for iron deficiency, autoimmune work-up for AIHA, drug review for aplastic anemia, infection screening for hemolytic crises." },
    { icon: "2.", title: "Nutritional Replacement", body: "Iron (oral ferrous sulfate preferred; IV if intolerance/malabsorption). Folic acid (oral). Vitamin B12 (IM hydroxocobalamin if pernicious anemia; oral if dietary cause)." },
    { icon: "3.", title: "Blood Transfusion", body: "Reserve for symptomatic, severe, or life-threatening anemia (Hb <7 g/dL in stable patients, <8 in cardiac disease). Risks: alloimmunization, iron overload (chronic), transfusion reactions." },
    { icon: "4.", title: "EPO-Stimulating Agents", body: "Erythropoietin or darbepoetin for CKD-related anemia and chemotherapy-induced anemia. Must ensure adequate iron stores." },
    { icon: "5.", title: "Immunosuppression", body: "ATG + cyclosporine for aplastic anemia. Steroids/rituximab for AIHA. Eculizumab for PNH." },
    { icon: "6.", title: "Curative / Definitive Therapies", body: "Allogeneic BMT: aplastic anemia, thalassemia major, sickle cell disease. Splenectomy: hereditary spherocytosis, refractory ITP/AIHA. Hydroxyurea: sickle cell (↑ HbF)." },
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 17 – Summary Table
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    ["Anemia of Chron. Inflam.", "N/↓", "↓ TIBC, underlying disease", "↑", "Treat cause, EPO"],
    ["B12 Deficiency", "↑", "Neurological signs, hyperseg PMNs, ↑ MMA", "N", "IM B12"],
    ["Folate Deficiency", "↑", "Hyperseg PMNs, ↑ homocysteine, NO neuro signs", "N", "Oral folate"],
    ["Aplastic Anemia", "N", "Pancytopenia, hypocellular BM", "↑", "BMT / IST"],
    ["Hereditary Spherocytosis", "N", "Spherocytes, ↑ osmotic fragility", "N", "Splenectomy"],
    ["Sickle Cell Disease", "N", "Sickle cells, HbS on electrophoresis", "N", "Hydroxyurea, BMT"],
    ["Thalassemia Major", "↓↓", "Target cells, HbA2/HbF ↑, BM expansion", "↑", "Transfuse + chelate"],
    ["G6PD Deficiency", "N", "Bite cells, Heinz bodies, triggered by oxidants", "N", "Avoid triggers"],
    ["PNH", "N", "Dark urine, thrombosis, ↓ CD55/59", "N", "Eculizumab / BMT"],
    ["AIHA (warm)", "N", "Spherocytes, positive DAT", "N", "Steroids, rituximab"],
    ["MAHA (TTP/HUS)", "N", "Schistocytes, thrombocytopenia", "N", "Plasma exchange"],
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 18 – Key Clinical Pearls
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    ["Ferritin is the first test to fall in iron deficiency", "Serum ferritin drops before serum iron or Hb changes — it is the most sensitive early marker."],
    ["Neurological symptoms = B12, not folate", "Both cause megaloblastic anemia, but subacute combined degeneration of the cord is exclusively B12 deficiency."],
    ["ACI: both serum iron AND TIBC are low", "This distinguishes ACI from IDA (where TIBC is high). Ferritin is also raised (acute phase reactant)."],
    ["Reticulocytosis = bone marrow response", "A rising reticulocyte count indicates the marrow is responding (e.g., post-iron therapy, post-hemorrhage). Absent reticulocytosis in anemia suggests bone marrow failure."],
    ["Schistocytes on smear = emergency", "Fragmented red cells (schistocytes) indicate MAHA — think TTP/HUS/DIC. TTP requires immediate plasma exchange."],
    ["Parvovirus B19 + hemolytic anemia = aplastic crisis", "In patients with chronic hemolytic anemias (HS, SCA), parvovirus B19 infects erythroblasts, transiently halting red cell production and causing sudden severe anemia."],
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 19 – Thank You / References
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    "Kumar V, Abbas AK, Aster JC. Robbins & Kumar Basic Pathology, 11th ed. Elsevier, 2023.",
    "WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011.",
    "Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372:1832-1843.",
    "Schrier SL. Approach to the adult patient with anemia. UpToDate. 2024.",
    "Goldman-Cecil Medicine, 27th ed. Elsevier, 2024.",
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// ── WRITE FILE ──────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/anemia-pptx/Anemia_Comprehensive_Overview.pptx" })
  .then(() => console.log("DONE: Anemia_Comprehensive_Overview.pptx created"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

cd /home/daytona/workspace/anemia-pptx && node build.js 2>&1

ls -lh /home/daytona/workspace/anemia-pptx/