Sickle Cell Anemia

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable
)
from reportlab.lib.styles import ParagraphStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER

OUTPUT = "/home/daytona/workspace/sickle-cell-pdf/Sickle_Cell_Anemia_Reference_Card.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
RED       = colors.HexColor("#C0392B")
DARK_RED  = colors.HexColor("#922B21")
LIGHT_RED = colors.HexColor("#FADBD8")
GREY_BG   = colors.HexColor("#F4F6F7")
MID_GREY  = colors.HexColor("#AAB7B8")
DARK      = colors.HexColor("#1C2833")
WHITE     = colors.white

# ── Styles ───────────────────────────────────────────────────────────────────
def S(name, **kw):
    base = dict(fontName="Helvetica", fontSize=7.5, leading=10,
                textColor=DARK, spaceAfter=0, spaceBefore=0)
    base.update(kw)
    return ParagraphStyle(name, **base)

title_style   = S("title",   fontName="Helvetica-Bold", fontSize=17,
                  textColor=WHITE, alignment=TA_CENTER, leading=20)
sub_style     = S("sub",     fontName="Helvetica", fontSize=8,
                  textColor=WHITE, alignment=TA_CENTER)
sec_style     = S("sec",     fontName="Helvetica-Bold", fontSize=8,
                  textColor=WHITE)
body_style    = S("body")
bold_style    = S("bold",    fontName="Helvetica-Bold")
small_style   = S("small",   fontSize=6.8, textColor=colors.HexColor("#555"))
bullet_style  = S("bullet",  leftIndent=8, bulletIndent=0,
                  bulletText="\u2022  ")

W, H = A4
MARGIN = 10 * mm

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=MARGIN, rightMargin=MARGIN,
    topMargin=MARGIN,  bottomMargin=8*mm,
)

story = []

# ── HEADER BANNER ────────────────────────────────────────────────────────────
header_data = [[
    Paragraph("SICKLE CELL ANEMIA", title_style),
    Paragraph("Quick Reference Card  •  Robbins & Kumar Basic Pathology", sub_style),
]]
header_tbl = Table(header_data, colWidths=[(W - 2*MARGIN) * 0.58,
                                           (W - 2*MARGIN) * 0.42])
header_tbl.setStyle(TableStyle([
    ("BACKGROUND",  (0, 0), (-1, -1), RED),
    ("VALIGN",      (0, 0), (-1, -1), "MIDDLE"),
    ("TOPPADDING",  (0, 0), (-1, -1), 6),
    ("BOTTOMPADDING",(0,0), (-1, -1), 6),
    ("LEFTPADDING", (0, 0), (-1, -1), 8),
    ("ROUNDEDCORNERS", [4]),
]))
story.append(header_tbl)
story.append(Spacer(1, 4))

# ── helper: section header ───────────────────────────────────────────────────
def section_header(text):
    tbl = Table([[Paragraph(text, sec_style)]],
                colWidths=[W - 2*MARGIN])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",   (0, 0), (-1, -1), DARK_RED),
        ("TOPPADDING",   (0, 0), (-1, -1), 3),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 3),
        ("LEFTPADDING",  (0, 0), (-1, -1), 6),
    ]))
    return tbl

def shaded_table(data, col_widths, header_bg=RED):
    tbl = Table(data, colWidths=col_widths, repeatRows=1)
    style = [
        ("BACKGROUND",   (0, 0), (-1, 0), header_bg),
        ("TEXTCOLOR",    (0, 0), (-1, 0), WHITE),
        ("FONTNAME",     (0, 0), (-1, 0), "Helvetica-Bold"),
        ("FONTSIZE",     (0, 0), (-1, -1), 7.2),
        ("LEADING",      (0, 0), (-1, -1), 9.5),
        ("ROWBACKGROUNDS",(0, 1), (-1, -1), [WHITE, GREY_BG]),
        ("GRID",         (0, 0), (-1, -1), 0.3, MID_GREY),
        ("TOPPADDING",   (0, 0), (-1, -1), 2.5),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 2.5),
        ("LEFTPADDING",  (0, 0), (-1, -1), 4),
        ("VALIGN",       (0, 0), (-1, -1), "TOP"),
    ]
    tbl.setStyle(TableStyle(style))
    return tbl

CW = W - 2 * MARGIN   # usable width

# ══════════════════════════════════════════════════════════════════════════════
# ROW 1 — Definition/Genetics  |  Pathogenesis
# ══════════════════════════════════════════════════════════════════════════════
LEFT_W  = CW * 0.38
RIGHT_W = CW * 0.62
GAP = 3

def left_cell():
    items = []
    items.append(section_header("DEFINITION & GENETICS"))
    items.append(Spacer(1, 2))
    def_data = [
        ["Gene",        "β-globin (chromosome 11)"],
        ["Mutation",    "GAG→GTG  →  Glu6Val (valine replaces\nglutamate at position 6 of β-globin)"],
        ["Hb formed",   "HbS (α₂β²S)"],
        ["Inheritance", "Autosomal recessive"],
        ["Homozygote",  "Sickle cell DISEASE (HbSS)"],
        ["Heterozygote","Sickle cell TRAIT (HbAS)\n— usually asymptomatic"],
    ]
    t = Table(def_data, colWidths=[LEFT_W*0.35, LEFT_W*0.65])
    t.setStyle(TableStyle([
        ("FONTNAME",  (0, 0), (0, -1), "Helvetica-Bold"),
        ("FONTNAME",  (1, 0), (1, -1), "Helvetica"),
        ("FONTSIZE",  (0, 0), (-1, -1), 7),
        ("LEADING",   (0, 0), (-1, -1), 9),
        ("ROWBACKGROUNDS",(0,0),(-1,-1),[WHITE, GREY_BG]),
        ("GRID",      (0, 0), (-1, -1), 0.3, MID_GREY),
        ("TOPPADDING",(0, 0), (-1, -1), 2),
        ("BOTTOMPADDING",(0,0),(-1,-1), 2),
        ("LEFTPADDING",(0,0),(-1,-1), 3),
        ("VALIGN",    (0,0), (-1,-1), "TOP"),
    ]))
    items.append(t)

    items.append(Spacer(1, 4))
    items.append(section_header("EPIDEMIOLOGY"))
    items.append(Spacer(1, 2))
    epi = [
        "~8% of African-Americans are HbS carriers",
        "1 in 600 African-Americans have sickle cell anemia",
        "HbS prevalent where P. falciparum malaria is/was endemic (equatorial Africa, parts of India, S. Europe)",
        "Median life expectancy: ~5th decade",
    ]
    for e in epi:
        items.append(Paragraph(f"• {e}", S("ep", fontSize=7, leading=9.5, leftIndent=4)))
    return items

def right_cell():
    items = []
    items.append(section_header("PATHOGENESIS"))
    items.append(Spacer(1, 2))

    path_text = (
        "On <b>deoxygenation</b>, HbS undergoes conformational change → <b>polymerization</b> "
        "via abnormal intermolecular contacts at Val6 → distorts RBC into elongated sickle shape."
    )
    items.append(Paragraph(path_text, S("pt", fontSize=7, leading=9.5)))
    items.append(Spacer(1, 3))

    factors_data = [
        ["Factor", "Effect"],
        ["Co-existing HbF or HbA", "Retard HbS polymerization — newborns protected until HbF falls (~5–6 months)"],
        ["HbS concentration", "Dehydration ↑ concentration → promotes sickling; α-thalassemia is protective"],
        ["Microvascular transit time", "Slow-flow organs (spleen, marrow) most at risk; inflammation worsens sickling"],
    ]
    items.append(shaded_table(factors_data, [RIGHT_W*0.32, RIGHT_W*0.68]))
    items.append(Spacer(1, 3))

    conseq_text = "<b>Two major consequences:</b>"
    items.append(Paragraph(conseq_text, S("ct", fontSize=7, fontName="Helvetica-Bold")))
    conseq = [
        "<b>Chronic hemolytic anemia</b> — RBC lifespan ~20 days (normal ~120); severity ∝ irreversibly sickled cells",
        "<b>Vascular occlusion</b> — ischemia, pain crises; triggered by infection, dehydration, acidosis, inflammation",
    ]
    for c in conseq:
        items.append(Paragraph(f"• {c}", S("cp", fontSize=7, leading=9.5, leftIndent=4)))
    return items

lc = left_cell()
rc = right_cell()
# pad to same length
while len(lc) < len(rc): lc.append(Spacer(1, 1))
while len(rc) < len(lc): rc.append(Spacer(1, 1))

row1 = Table([[lc, rc]], colWidths=[LEFT_W, RIGHT_W])
row1.setStyle(TableStyle([
    ("VALIGN",      (0,0), (-1,-1), "TOP"),
    ("LEFTPADDING", (0,0), (-1,-1), 0),
    ("RIGHTPADDING",(0,0), (-1,-1), GAP),
    ("TOPPADDING",  (0,0), (-1,-1), 0),
    ("BOTTOMPADDING",(0,0),(-1,-1), 0),
]))
story.append(row1)
story.append(Spacer(1, 4))

# ══════════════════════════════════════════════════════════════════════════════
# ROW 2 — Clinical Crises  |  Organ Complications
# ══════════════════════════════════════════════════════════════════════════════
L2 = CW * 0.52
R2 = CW * 0.48

crises_items = []
crises_items.append(section_header("CLINICAL CRISES"))
crises_items.append(Spacer(1, 2))
crises_data = [
    ["Crisis", "Trigger", "Features"],
    ["Vaso-occlusive\n(pain)", "Infection, dehydration,\ncold, acidosis",
     "Bone pain, acute chest syndrome,\nstroke, priapism"],
    ["Aplastic", "Parvovirus B19\n(infects erythroblasts)",
     "Sudden ↓ RBC production;\nself-limited"],
    ["Sequestration", "Trapped sickled RBCs\nin spleen/liver",
     "Sudden massive splenomegaly,\nrapid anemia (mainly children)"],
    ["Hemolytic", "Accelerated RBC\ndestruction",
     "Worsening anemia, jaundice"],
]
crises_items.append(shaded_table(crises_data, [L2*0.22, L2*0.30, L2*0.48]))

organ_items = []
organ_items.append(section_header("ORGAN COMPLICATIONS"))
organ_items.append(Spacer(1, 2))
organ_data = [
    ["Organ/System", "Complication"],
    ["Spleen",       "Autosplenectomy (children: splenomegaly → adult: fibrotic nubbin)"],
    ["Bone",         "'Crew-cut' skull on X-ray; osteomyelitis (Salmonella, E. coli)"],
    ["Brain",        "Stroke (infarction from vascular occlusion)"],
    ["Lung",         "Acute chest syndrome"],
    ["Kidney",       "Renal tubular fatty change, papillary necrosis"],
    ["Eye",          "Retinal infarction → blindness"],
    ["Liver/Heart",  "Fatty change from chronic hypoxia"],
    ["Gallbladder",  "Pigment gallstones (↑ bilirubin from hemolysis)"],
    ["Penis",        "Priapism → fibrosis, erectile dysfunction"],
    ["Infection risk","Encapsulated bacteria (pneumococci, H. influenzae, meningococci)"],
]
organ_items.append(shaded_table(organ_data, [R2*0.30, R2*0.70]))

row2 = Table([[crises_items, organ_items]], colWidths=[L2, R2])
row2.setStyle(TableStyle([
    ("VALIGN",      (0,0), (-1,-1), "TOP"),
    ("LEFTPADDING", (0,0), (-1,-1), 0),
    ("RIGHTPADDING",(0,0), (-1,-1), GAP),
    ("TOPPADDING",  (0,0), (-1,-1), 0),
    ("BOTTOMPADDING",(0,0),(-1,-1), 0),
]))
story.append(row2)
story.append(Spacer(1, 4))

# ══════════════════════════════════════════════════════════════════════════════
# ROW 3 — Diagnosis  |  Treatment
# ══════════════════════════════════════════════════════════════════════════════
L3 = CW * 0.42
R3 = CW * 0.58

diag_items = []
diag_items.append(section_header("DIAGNOSIS"))
diag_items.append(Spacer(1, 2))
diag_data = [
    ["Test", "Finding"],
    ["Peripheral smear", "Irreversibly sickled cells, anisocytosis, poikilocytosis"],
    ["Hb electrophoresis", "HbSS (no HbA) in disease;\nHbAS ~50:50 in trait"],
    ["Newborn screening", "Mandated in US — gel electrophoresis on heel-stick blood"],
    ["Prenatal diagnosis", "DNA analysis via amniocentesis or CVS"],
    ["Sickling test", "In vitro hypoxia induces sickling in HbAS trait cells"],
]
diag_items.append(shaded_table(diag_data, [L3*0.38, L3*0.62]))

tx_items = []
tx_items.append(section_header("TREATMENT"))
tx_items.append(Spacer(1, 2))
tx_data = [
    ["Treatment", "Mechanism / Notes"],
    ["Hydroxyurea", "↑ HbF; anti-inflammatory (↓ WBC); ↑ RBC size (↓ [HbS]);\nmetabolized to NO → vasodilation, anti-platelet"],
    ["Penicillin prophylaxis", "Prevent pneumococcal infections in children <5 yrs"],
    ["Vaccination", "Pneumococcus, H. influenzae type b, meningococcus"],
    ["Transfusion /\nExchange transfusion", "Target HbS <40%, Hb ~10 g/dL;\nexchange preferred in stroke, acute chest syndrome"],
    ["Bone marrow transplant", "Potentially curative (allogeneic)"],
    ["Gene therapy", "Corrective — increasingly promising"],
    ["Folic acid", "Compensate for ↑ RBC turnover"],
]
tx_items.append(shaded_table(tx_data, [R3*0.30, R3*0.70]))

row3 = Table([[diag_items, tx_items]], colWidths=[L3, R3])
row3.setStyle(TableStyle([
    ("VALIGN",      (0,0), (-1,-1), "TOP"),
    ("LEFTPADDING", (0,0), (-1,-1), 0),
    ("RIGHTPADDING",(0,0), (-1,-1), GAP),
    ("TOPPADDING",  (0,0), (-1,-1), 0),
    ("BOTTOMPADDING",(0,0),(-1,-1), 0),
]))
story.append(row3)
story.append(Spacer(1, 4))

# ══════════════════════════════════════════════════════════════════════════════
# FOOTER — Key Memory Points
# ══════════════════════════════════════════════════════════════════════════════
story.append(section_header("KEY MEMORY POINTS"))
story.append(Spacer(1, 2))

key_points = [
    "<b>Mutation:</b> GAG→GTG  •  Glu→Val at β-globin position 6  •  A→T transversion",
    "<b>HbF protective:</b> Newborns asymptomatic until ~5–6 months when HbF replaced by HbS",
    "<b>Autosplenectomy</b> → functional asplenia → susceptibility to <b>encapsulated bacteria</b>",
    "<b>Crew-cut skull</b> on X-ray from marrow hyperplasia; <b>Salmonella</b> osteomyelitis is classic",
    "<b>Parvovirus B19</b> → aplastic crisis  •  Dehydration/hypoxia/acidosis/infection trigger vaso-occlusive crisis",
    "<b>Hydroxyurea</b> = mainstay of therapy (↑ HbF + anti-inflammatory + NO production)",
    "RBC lifespan <b>~20 days</b> (vs normal ~120 days)  •  ~50% survive beyond 5th decade with modern care",
]
kp_data = [[Paragraph(p, S("kp", fontSize=7, leading=9.5))] for p in key_points]
kp_tbl = Table(kp_data, colWidths=[CW])
kp_tbl.setStyle(TableStyle([
    ("ROWBACKGROUNDS",(0,0),(-1,-1),[WHITE, LIGHT_RED]),
    ("GRID",         (0,0),(-1,-1), 0.3, MID_GREY),
    ("TOPPADDING",   (0,0),(-1,-1), 2.5),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2.5),
    ("LEFTPADDING",  (0,0),(-1,-1), 5),
    ("VALIGN",       (0,0),(-1,-1), "MIDDLE"),
]))
story.append(kp_tbl)

story.append(Spacer(1, 3))
story.append(Paragraph(
    "Source: Robbins &amp; Kumar Basic Pathology (10th ed.) — For educational use only",
    S("footer", fontSize=6, textColor=MID_GREY, alignment=TA_CENTER)
))

doc.build(story)
print("PDF created:", OUTPUT)