const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Orris Medical";
pres.title = "Exchange Transfusion: Pathological Basis and Clinical Integration";

// ─── PALETTE ──────────────────────────────────────────────────────────────────
const DARK_BG    = "0D1B2A";   // deep navy – title / section dividers
const MID_BG     = "1B3A5C";   // medium navy – accent panels
const CARD_BG    = "F0F4F8";   // light slate – content cards
const WHITE      = "FFFFFF";
const ACCENT1    = "E63946";   // vivid red – key callouts
const ACCENT2    = "2EC4B6";   // teal – sub-highlights
const ACCENT3    = "F4A261";   // amber – warnings / complications
const TEXT_DARK  = "0D1B2A";
const TEXT_MID   = "2C3E50";
const TEXT_LIGHT = "ECF0F1";

// ─── HELPERS ──────────────────────────────────────────────────────────────────
function darkSlide(slide) {
  slide.background = { color: DARK_BG };
}
function lightSlide(slide) {
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}
function sectionBanner(slide, label) {
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  slide.addText(label.toUpperCase(), {
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    color: WHITE, charSpacing: 3, valign: "middle", margin: 0
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}
function slideTitle(slide, title, dark = false) {
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    x: 0.4, y: 1.35, w: 1.2, h: 0.055, fill: { color: ACCENT1 }
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}
function bulletList(slide, items, opts = {}) {
  const { x = 0.4, y = 1.55, w = 9.2, h = 3.7, fontSize = 14, color = TEXT_DARK, indent = 0 } = opts;
  const textArr = items.map((item, i) => {
    const isLast = i === items.length - 1;
    if (typeof item === "string") {
      return { text: item, options: { bullet: { indent: 15 + indent }, breakLine: !isLast, fontSize, color } };
    }
    // object: {text, sub, bold, accent}
    return {
      text: item.text,
      options: {
        bullet: { indent: 15 + indent },
        breakLine: !isLast,
        fontSize: item.fontSize || fontSize,
        bold: !!item.bold,
        color: item.accent ? ACCENT1 : (item.teal ? ACCENT2 : color)
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function infoCard(slide, x, y, w, h, title, body, titleColor = ACCENT2, bgColor = CARD_BG) {
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  slide.addText(body, { x: x + 0.12, y: y + 0.44, w: w - 0.22, h: h - 0.52, fontSize: 11, color: TEXT_DARK, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.2 });
}


// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);

  // background gradient stripe
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 3.2, h: 5.625, fill: { color: MID_BG } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: 10, h: 0.825, fill: { color: ACCENT1 } });

  // icon circle
  s.addShape(pres.ShapeType.ellipse, { x: 0.6, y: 1.0, w: 2.0, h: 2.0, fill: { color: ACCENT1 }, line: { color: WHITE, width: 2 } });
  s.addText("ET", { x: 0.6, y: 1.0, w: 2.0, h: 2.0, fontSize: 38, bold: true, color: WHITE, align: "center", valign: "middle" });

  s.addText("EXCHANGE TRANSFUSION", {
    x: 3.4, y: 1.1, w: 6.2, h: 1.0, fontSize: 28, bold: true,
    color: WHITE, fontFace: "Calibri", charSpacing: 2
  });
  s.addText("Pathological Basis &\nClinical Integration", {
    x: 3.4, y: 2.15, w: 6.2, h: 1.2, fontSize: 20,
    color: ACCENT2, fontFace: "Calibri"
  });
  s.addText("Blood Banking · Transfusion Medicine · Clinical Pathology", {
    x: 3.4, y: 3.4, w: 6.2, h: 0.5, fontSize: 12,
    color: "A0B4C8", fontFace: "Calibri"
  });
  s.addText("Sources: Quick Compendium · Henry's · Harriet Lane · Harrison's · Goldman-Cecil", {
    x: 0.2, y: 4.85, w: 9.6, h: 0.55, fontSize: 9.5,
    color: WHITE, align: "center", valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – DEFINITION & PRINCIPLES
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Definition & Principles");
  slideTitle(s, "What is Exchange Transfusion?");

  // Definition box
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.5, w: 9.2, h: 0.9, fill: { color: MID_BG }, line: { color: MID_BG } });
  s.addText("Simultaneous removal of patient's blood and replacement with donor blood — removing pathological substances while restoring normal haematological function", {
    x: 0.55, y: 1.52, w: 8.9, h: 0.86, fontSize: 13, color: WHITE, italic: true, valign: "middle", fontFace: "Calibri"
  });

  // Two cards
  infoCard(s, 0.4, 2.55, 4.4, 2.7, "Simple (Manual) Exchange",
    "Push-pull technique\nUmbilical catheters (UAC/UVC)\nAliquot-based: 15 mL/full-term\n2–3 mL/kg/min for premature infants\nManual operator control", ACCENT1);

  infoCard(s, 5.0, 2.55, 4.6, 2.7, "Automated RCE (Apheresis)",
    "Machine-mediated exchange\nMore precise HbS% control\nFewer donor RBC units needed\nLower iron overload contribution\nUsed predominantly in SCD", ACCENT2);

  s.addText("Henry's Clinical Diagnosis & Management by Laboratory Methods", {
    x: 0.4, y: 5.35, w: 9.2, h: 0.22, fontSize: 8.5, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – PATHOLOGICAL BASIS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Pathological Basis");
  slideTitle(s, "Why Exchange Transfusion? — Core Pathological Mechanisms");

  const mechanisms = [
    { x: 0.3, y: 1.55, color: ACCENT1, num: "01", title: "Hyperbilirubinemia", body: "Unconjugated bilirubin exceeds\nalbumin-binding capacity\n→ Crosses BBB\n→ Binds basal ganglia, hippocampus,\n    brainstem nuclei → Kernicterus\nCanalicular excretion immature\nin neonates (Harrison's 22E)" },
    { x: 3.6, y: 1.55, color: ACCENT2, num: "02", title: "Sickling Pathology", body: "HbS polymerises under hypoxia\n→ RBC sickling\n→ Vaso-occlusion & hemolysis\n→ Multi-organ damage\nExchange removes HbS-bearing cells\nwithout raising hematocrit/viscosity" },
    { x: 6.9, y: 1.55, color: ACCENT3, num: "03", title: "Immune Haemolysis", body: "Maternal IgG crosses placenta\n→ Coats fetal RBCs\n→ Extravascular hemolysis\n→ Hyperbilirubinaemia + anaemia\nExchange clears antibody-coated\ncells and free bilirubin" },
  ];

  mechanisms.forEach(m => {
    s.addShape(pres.ShapeType.rect, { x: m.x, y: m.y, w: 3.1, h: 3.7, fill: { color: CARD_BG }, line: { color: "D0D8E0", width: 0.75 } });
    s.addShape(pres.ShapeType.ellipse, { x: m.x + 0.9, y: m.y + 0.15, w: 1.3, h: 1.3, fill: { color: m.color } });
    s.addText(m.num, { x: m.x + 0.9, y: m.y + 0.15, w: 1.3, h: 1.3, fontSize: 22, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(m.title, { x: m.x + 0.15, y: m.y + 1.6, w: 2.8, h: 0.42, fontSize: 13, bold: true, color: m.color, align: "center" });
    s.addText(m.body, { x: m.x + 0.15, y: m.y + 2.05, w: 2.8, h: 1.55, fontSize: 10.5, color: TEXT_DARK, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.25 });
  });

  s.addText("Exchange addresses ALL three: removes bilirubin, replaces HbS cells, clears antibody-coated RBCs", {
    x: 0.3, y: 5.28, w: 9.4, h: 0.3, fontSize: 10.5, bold: true, color: ACCENT1, italic: true, align: "center"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – NEONATAL HYPERBILIRUBINAEMIA
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Indication 1 — Neonatal Hyperbilirubinemia");
  slideTitle(s, "HDN: Bilirubin Encephalopathy & Exchange Thresholds");

  // Left column – thresholds
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.55, w: 4.5, h: 3.8, fill: { color: CARD_BG }, line: { color: "D0D8E0" } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.55, w: 4.5, h: 0.38, fill: { color: ACCENT1 } });
  s.addText("Exchange Thresholds (≥35 wks)", { x: 0.4, y: 1.57, w: 4.3, h: 0.34, fontSize: 11, bold: true, color: WHITE, valign: "middle", margin: 0 });

  s.addText([
    { text: "TSB > 25 mg/dL", options: { bullet: true, bold: true, color: ACCENT1, fontSize: 12, breakLine: true } },
    { text: "(Henry's – generally accepted threshold)", options: { fontSize: 10, color: TEXT_MID, breakLine: true } },
    { text: "Serum bilirubin > 20 mg/dL", options: { bullet: true, bold: true, color: TEXT_DARK, fontSize: 12, breakLine: true } },
    { text: "(Lee's Otolaryngology – classic)", options: { fontSize: 10, color: TEXT_MID, breakLine: true } },
    { text: "IMMEDIATE exchange if:", options: { bullet: true, bold: true, color: ACCENT3, fontSize: 12, breakLine: true } },
    { text: "  • Hypertonia / arching / opisthotonos", options: { fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "  • Retrocollis, high-pitched cry, fever", options: { fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "  • TSB ≥5 mg/dL above nomogram line", options: { fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "Risk factors ↓ threshold:", options: { bullet: true, bold: true, fontSize: 11, color: MID_BG, breakLine: true } },
    { text: "  Isoimmune HDN · G6PD deficiency · Asphyxia\n  Lethargy · Temp instability · Sepsis · Acidosis", options: { fontSize: 10.5, color: TEXT_DARK } },
  ], { x: 0.42, y: 2.0, w: 4.2, h: 3.25, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.15 });

  // Right column – pre-exchange labs
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.55, w: 4.6, h: 3.8, fill: { color: CARD_BG }, line: { color: "D0D8E0" } });
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.55, w: 4.6, h: 0.38, fill: { color: MID_BG } });
  s.addText("Mandatory Pre-Exchange Labs", { x: 5.2, y: 1.57, w: 4.4, h: 0.34, fontSize: 11, bold: true, color: WHITE, valign: "middle", margin: 0 });

  s.addText([
    { text: "⚠ Diagnostic value ONLY on pre-exchange sample!", options: { bold: true, color: ACCENT1, fontSize: 11, breakLine: true } },
    { text: "Post-exchange blood has NO diagnostic value", options: { italic: true, color: ACCENT3, fontSize: 10.5, breakLine: true } },
    { text: " ", options: { fontSize: 8, breakLine: true } },
    { text: "CBC + differential", options: { bullet: true, fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "Reticulocyte count + peripheral smear", options: { bullet: true, fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "Total & direct bilirubin", options: { bullet: true, fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "Ionised Ca²⁺, glucose, total protein/albumin", options: { bullet: true, fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "B/A (bilirubin/albumin) ratio", options: { bullet: true, fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "Blood type + Direct Coombs (DAT)", options: { bullet: true, fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "Newborn metabolic screen", options: { bullet: true, fontSize: 11, color: TEXT_DARK, breakLine: true } },
    { text: "Save pre-exchange blood for serologic/genetic studies", options: { bullet: true, bold: true, fontSize: 10.5, color: MID_BG } },
  ], { x: 5.22, y: 1.99, w: 4.35, h: 3.28, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.15 });

  s.addText("The Harriet Lane Handbook, 23rd ed. | Henry's Clinical Diagnosis & Management", {
    x: 0.3, y: 5.35, w: 9.4, h: 0.22, fontSize: 8.5, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – HDFN
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Indication 2 — Haemolytic Disease of the Fetus & Newborn (HDFN)");
  slideTitle(s, "HDFN: Pathology, Lab Diagnosis & Exchange Role");

  // Pathophysiology flow
  const flowItems = ["Maternal IgG formed", "IgG crosses placenta", "Coats fetal RBCs", "Extravascular haemolysis", "↑ Bilirubin + Anaemia"];
  flowItems.forEach((txt, i) => {
    const xPos = 0.3 + i * 1.88;
    s.addShape(pres.ShapeType.rect, { x: xPos, y: 1.55, w: 1.65, h: 0.68, fill: { color: i % 2 === 0 ? ACCENT1 : MID_BG }, line: { color: "CCCCCC" } });
    s.addText(txt, { x: xPos + 0.04, y: 1.55, w: 1.57, h: 0.68, fontSize: 9.5, bold: true, color: WHITE, align: "center", valign: "middle" });
    if (i < 4) {
      s.addText("→", { x: xPos + 1.65, y: 1.62, w: 0.23, h: 0.52, fontSize: 16, bold: true, color: ACCENT1, align: "center" });
    }
  });

  // Antibodies card
  infoCard(s, 0.3, 2.42, 4.6, 1.8, "Common Causative Antibodies",
    "Anti-D (most significant)\nAnti-K · Anti-c · Anti-E\nAnti-Fyᵃ · Anti-Jkᵇ\nDuffy abs → capable of SEVERE HDN",
    ACCENT1, CARD_BG);

  // DAT card
  infoCard(s, 5.1, 2.42, 4.6, 1.8, "Lab Diagnosis (DAT Pattern in HDFN)",
    "Positive DAT:\n  IgG+ (most common)\n  IgG+/C3+ pattern\nPeripheral smear: spherocytes,\npolychromasia, nucleated RBCs",
    MID_BG, CARD_BG);

  // Management
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 4.35, w: 9.4, h: 1.1, fill: { color: "FFF3E0" }, line: { color: ACCENT3 } });
  s.addText("Management", { x: 0.45, y: 4.38, w: 2.0, h: 0.3, fontSize: 11, bold: true, color: ACCENT3 });
  s.addText([
    { text: "Exchange transfusion: ", options: { bold: true, fontSize: 10.5, color: TEXT_DARK } },
    { text: "indicated when infant did NOT receive intrauterine transfusion (IUT)   ", options: { fontSize: 10.5, color: TEXT_DARK } },
    { text: "  |  IVIG: ", options: { bold: true, fontSize: 10.5, color: TEXT_DARK } },
    { text: "0.5–1 g/kg in isoimmune haemolytic disease (may reduce/delay exchange need)", options: { fontSize: 10.5, color: TEXT_DARK } },
  ], { x: 0.45, y: 4.72, w: 9.1, h: 0.68, valign: "top", fontFace: "Calibri" });

  s.addText("Quick Compendium of Clinical Pathology 5th ed. | Henry's | Harriet Lane | Tintinalli's Emergency Medicine", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.2, fontSize: 8, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – BLOOD PRODUCT SELECTION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Blood Product Selection — Neonatal Exchange");
  slideTitle(s, "What Blood to Use for Neonatal Exchange Transfusion?");

  const checks = [
    { label: "FRESH", detail: "< 5 days old (if unavailable → washed RBCs)", color: ACCENT2 },
    { label: "IRRADIATED", detail: "Prevents TA-GVHD (transfusion-associated graft-vs-host disease)", color: ACCENT1 },
    { label: "GROUP O", detail: "Universal donor for neonates", color: MID_BG },
    { label: "ANTIBODY –ve", detail: "Negative for any active maternal antibody (e.g. anti-D)", color: ACCENT3 },
    { label: "CMV-SAFE", detail: "Seronegative OR leukoreduced — for preemies <1200 g or IUT", color: "7B68EE" },
    { label: "Hct ~45%", detail: "Reconstituted RBCs + compatible plasma (whole blood OR reconstituted)", color: "2E86AB" },
  ];

  checks.forEach((c, i) => {
    const row = Math.floor(i / 2);
    const col = i % 2;
    const xPos = 0.3 + col * 4.9;
    const yPos = 1.55 + row * 1.2;
    s.addShape(pres.ShapeType.rect, { x: xPos, y: yPos, w: 4.55, h: 1.05, fill: { color: CARD_BG }, line: { color: "D0D8E0" } });
    s.addShape(pres.ShapeType.rect, { x: xPos, y: yPos, w: 1.3, h: 1.05, fill: { color: c.color } });
    s.addText("✓ " + c.label, { x: xPos + 0.05, y: yPos, w: 1.2, h: 1.05, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(c.detail, { x: xPos + 1.38, y: yPos, w: 3.1, h: 1.05, fontSize: 11, color: TEXT_DARK, valign: "middle", fontFace: "Calibri", lineSpacingMultiple: 1.2 });
  });

  // TA-GVHD warning
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 5.1, w: 9.4, h: 0.38, fill: { color: "FFE8E8" }, line: { color: ACCENT1 } });
  s.addText("⚠ TA-GVHD: Onset 2–50 days post-transfusion. Rash, diarrhoea, fever, liver dysfunction, pancytopenia. Mortality >90%. Irradiation is MANDATORY for large-volume neonatal exchange.", {
    x: 0.42, y: 5.11, w: 9.1, h: 0.36, fontSize: 9.5, color: ACCENT1, valign: "middle", fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – PROCEDURE TECHNIQUE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Procedure — Technique & Volume");
  slideTitle(s, "How to Perform Exchange Transfusion: Step-by-Step");

  const steps = [
    { num: "1", title: "Catheter Placement", body: "Blood OUT via UAC\nBlood IN via UVC\nIf UAC unavailable: peripheral arterial\nline or single venous catheter" },
    { num: "2", title: "Volume Calculation", body: "2 × blood volume exchange\n2 × 80 mL/kg = ~160 mL/kg\nReplaces ~85% of circulation\nRed cell mass ↓ by ~70%" },
    { num: "3", title: "Exchange Rate", body: "Full-term: 15 mL aliquots\nPremature/unstable:\n  2–3 mL/kg/min (slower)\n  to avoid haemolysis" },
    { num: "4", title: "Expected Outcome", body: "Total bilirubin ↓ by ~25%\nFetal RBC mass ↓ by ~70%\nHbS reduced without\nraising haematocrit" },
  ];

  steps.forEach((st, i) => {
    const xPos = 0.3 + i * 2.4;
    s.addShape(pres.ShapeType.rect, { x: xPos, y: 1.52, w: 2.2, h: 3.7, fill: { color: CARD_BG }, line: { color: "D0D8E0" } });
    s.addShape(pres.ShapeType.ellipse, { x: xPos + 0.45, y: 1.62, w: 1.3, h: 1.0, fill: { color: i % 2 === 0 ? ACCENT1 : ACCENT2 } });
    s.addText(st.num, { x: xPos + 0.45, y: 1.62, w: 1.3, h: 1.0, fontSize: 28, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(st.title, { x: xPos + 0.1, y: 2.72, w: 2.0, h: 0.42, fontSize: 11.5, bold: true, color: TEXT_DARK, align: "center" });
    s.addText(st.body, { x: xPos + 0.1, y: 3.2, w: 2.0, h: 1.95, fontSize: 10.5, color: TEXT_DARK, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.25 });
  });

  // monitoring strip
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 5.1, w: 9.4, h: 0.42, fill: { color: MID_BG } });
  s.addText("Monitor: QTc (hypocalcaemia from citrate) · Hemodynamics · Electrolytes · Blood glucose · Temperature", {
    x: 0.45, y: 5.12, w: 9.1, h: 0.38, fontSize: 10.5, color: WHITE, valign: "middle", bold: false
  });

  s.addText("The Harriet Lane Handbook, 23rd ed.", {
    x: 0.3, y: 5.42, w: 9.4, h: 0.18, fontSize: 8, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – SICKLE CELL DISEASE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Indication 3 — Sickle Cell Disease (SCD)");
  slideTitle(s, "Exchange Transfusion in Sickle Cell Disease");

  // Mnemonic box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.52, w: 4.35, h: 0.75, fill: { color: ACCENT1 } });
  s.addText("Mnemonic — Emergency Indications: \"SRSA-AP\"", { x: 0.4, y: 1.54, w: 4.15, h: 0.71, fontSize: 11.5, bold: true, color: WHITE, valign: "middle" });

  s.addText([
    { text: "S", options: { bold: true, color: ACCENT1, fontSize: 14, breakLine: false } },
    { text: "troke (most common — 11% of SCD patients by age 20)  ", options: { fontSize: 12, color: TEXT_DARK, breakLine: true } },
    { text: "R", options: { bold: true, color: ACCENT1, fontSize: 14 } },
    { text: "etinal artery occlusion  ", options: { fontSize: 12, color: TEXT_DARK, breakLine: true } },
    { text: "S", options: { bold: true, color: ACCENT1, fontSize: 14 } },
    { text: "plenic sequestration crisis  ", options: { fontSize: 12, color: TEXT_DARK, breakLine: true } },
    { text: "A", options: { bold: true, color: ACCENT1, fontSize: 14 } },
    { text: "cute chest syndrome (ACS) — 20–50% of SCD; mortality 2–14%  ", options: { fontSize: 12, color: TEXT_DARK, breakLine: true } },
    { text: "A", options: { bold: true, color: ACCENT2, fontSize: 14 } },
    { text: "plastic crisis  ", options: { fontSize: 12, color: TEXT_DARK, breakLine: true } },
    { text: "P", options: { bold: true, color: ACCENT2, fontSize: 14 } },
    { text: "riapism (fulminant, >6 hrs, failed medical Rx)", options: { fontSize: 12, color: TEXT_DARK } },
  ], { x: 0.4, y: 2.36, w: 4.2, h: 3.0, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.25 });

  // Elective / chronic
  s.addShape(pres.ShapeType.rect, { x: 4.85, y: 1.52, w: 4.85, h: 3.85, fill: { color: CARD_BG }, line: { color: "D0D8E0" } });
  s.addShape(pres.ShapeType.rect, { x: 4.85, y: 1.52, w: 4.85, h: 0.38, fill: { color: ACCENT2 } });
  s.addText("Elective / Chronic Indications", { x: 4.95, y: 1.54, w: 4.65, h: 0.34, fontSize: 11, bold: true, color: WHITE, valign: "middle", margin: 0 });
  s.addText([
    { text: "Abnormal transcranial Doppler (stroke prevention in children)", options: { bullet: true, fontSize: 11.5, color: TEXT_DARK, breakLine: true } },
    { text: "Progressive renal / cardiopulmonary disease", options: { bullet: true, fontSize: 11.5, color: TEXT_DARK, breakLine: true } },
    { text: "Complicated pregnancy", options: { bullet: true, fontSize: 11.5, color: TEXT_DARK, breakLine: true } },
    { text: " ", options: { fontSize: 8, breakLine: true } },
    { text: "HbS Targets:", options: { bold: true, fontSize: 12, color: MID_BG, breakLine: true } },
    { text: "Children: HbS < 30%", options: { bullet: true, bold: true, fontSize: 12, color: ACCENT1, breakLine: true } },
    { text: "Adults: HbS < 50%", options: { bullet: true, bold: true, fontSize: 12, color: ACCENT2, breakLine: true } },
    { text: " ", options: { fontSize: 8, breakLine: true } },
    { text: "Preoperative: High-risk (cardiac) surgery — exchange preferred over simple transfusion (simple Hb >9 g/dL adequate for low/moderate risk)", options: { bullet: true, fontSize: 10.5, color: TEXT_DARK } },
  ], { x: 4.97, y: 1.98, w: 4.6, h: 3.3, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.2 });

  s.addText("Quick Compendium 5th ed. | Goldman-Cecil Medicine | Henry's | STOP & STOP II Trials (Adams et al.)", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.2, fontSize: 8, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – RCE vs SIMPLE TRANSFUSION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Apheresis RCE vs Simple Transfusion — SCD Comparison");
  slideTitle(s, "Red Cell Exchange by Apheresis vs Simple Transfusion");

  // Table
  const headers = ["Feature", "RCE by Apheresis", "Simple Transfusion"];
  const rows = [
    ["HbS Reduction", "Greater, faster, precise", "Moderate"],
    ["Haematocrit Effect", "No rise — avoids hyperviscosity", "Rises — risk of hyperviscosity"],
    ["RBC Units Required", "Fewer units for same HbS%", "More units needed"],
    ["Iron Overload", "Lower contribution", "Higher accumulation"],
    ["STOP Trial", "Preferred for stroke prevention", "Equally effective low/mod surgery"],
    ["High-Risk Surgery", "Preferred (cardiac)", "Insufficient for high-risk"],
  ];

  const tW = [3.2, 3.2, 3.2];
  const tX = [0.25, 3.45, 6.65];
  const tY = 1.6;
  const rowH = 0.54;

  // Header
  headers.forEach((h, ci) => {
    s.addShape(pres.ShapeType.rect, { x: tX[ci], y: tY, w: tW[ci], h: 0.45, fill: { color: ci === 0 ? DARK_BG : (ci === 1 ? ACCENT2 : ACCENT3) } });
    s.addText(h, { x: tX[ci] + 0.08, y: tY, w: tW[ci] - 0.12, h: 0.45, fontSize: 11.5, bold: true, color: WHITE, valign: "middle", align: "center" });
  });

  rows.forEach((row, ri) => {
    const yRow = tY + 0.45 + ri * rowH;
    const bg = ri % 2 === 0 ? WHITE : CARD_BG;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: tX[ci], y: yRow, w: tW[ci], h: rowH, fill: { color: ci === 0 ? "E8EDF2" : bg }, line: { color: "D0D8E0", width: 0.5 } });
      s.addText(cell, { x: tX[ci] + 0.1, y: yRow, w: tW[ci] - 0.15, h: rowH, fontSize: 10.5, color: TEXT_DARK, valign: "middle", fontFace: "Calibri", bold: ci === 0 });
    });
  });

  s.addText("Goldman-Cecil Medicine | Henry's Clinical Diagnosis & Management by Laboratory Methods", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.2, fontSize: 8, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – OTHER INDICATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Indication 4 — Other Clinical Indications");
  slideTitle(s, "Beyond Bilirubin & SCD: Additional Indications");

  const cards = [
    { title: "Babesiosis (Severe)", body: "High parasitemia\nRemoves infected RBCs\nTreatment: Clindamycin\n+ Quinine + Exchange", color: ACCENT1 },
    { title: "Polycythaemia Neonatorum", body: "Venous Hct > 65%\nPartial exchange to\nreduce blood viscosity\nPrevents cerebral ischaemia", color: ACCENT2 },
    { title: "Hyperleukocytosis", body: "Acute leukaemia\nOnly if symptomatic\nleukostasis present\n(leukapheresis preferred)", color: ACCENT3 },
    { title: "Heavy Metal Poisoning", body: "Severe lead / toxic\nmetal exposure\nIf haemodialysis &\nchelation insufficient", color: MID_BG },
    { title: "Malaria (Severe)", body: "Hyperparasitaemia\nHistorically used\nNow less common\n(WHO guidance varies)", color: "7B68EE" },
    { title: "Renal Failure (Historical)", body: "Selected ESRD context\n(Brenner & Rector)\nLargely replaced by\nhaemodialysis", color: "2E86AB" },
  ];

  cards.forEach((c, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const xPos = 0.25 + col * 3.22;
    const yPos = 1.55 + row * 1.85;
    s.addShape(pres.ShapeType.rect, { x: xPos, y: yPos, w: 3.05, h: 1.7, fill: { color: CARD_BG }, line: { color: "D0D8E0" } });
    s.addShape(pres.ShapeType.rect, { x: xPos, y: yPos, w: 3.05, h: 0.38, fill: { color: c.color } });
    s.addText(c.title, { x: xPos + 0.08, y: yPos + 0.03, w: 2.9, h: 0.33, fontSize: 10.5, bold: true, color: WHITE, valign: "middle", margin: 0 });
    s.addText(c.body, { x: xPos + 0.1, y: yPos + 0.43, w: 2.85, h: 1.2, fontSize: 10.5, color: TEXT_DARK, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.25 });
  });

  s.addText("Medical Microbiology 9e | Harriet Lane | Roberts & Hedges' Emergency Procedures | Brenner & Rector's The Kidney", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.2, fontSize: 8, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – ASPEN SYNDROME
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: "0A1628" };

  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: ACCENT1 } });
  s.addText("HIGH-YIELD COMPLICATION — ASPEN SYNDROME", {
    x: 0.3, y: 0.03, w: 9.4, h: 0.5, fontSize: 11, bold: true, color: WHITE, charSpacing: 2, valign: "middle", margin: 0
  });

  // Acronym
  const letters = [
    { l: "A", txt: "Association of" },
    { l: "S", txt: "Sickle cell disease" },
    { l: "P", txt: "Priapism" },
    { l: "E", txt: "Exchange transfusion" },
    { l: "N", txt: "Neurologic events" },
  ];
  letters.forEach((lt, i) => {
    const xPos = 0.3 + i * 1.9;
    s.addShape(pres.ShapeType.ellipse, { x: xPos, y: 0.65, w: 1.5, h: 1.5, fill: { color: ACCENT1 } });
    s.addText(lt.l, { x: xPos, y: 0.65, w: 1.5, h: 1.0, fontSize: 32, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(lt.txt, { x: xPos - 0.1, y: 1.55, w: 1.7, h: 0.55, fontSize: 9.5, color: ACCENT2, align: "center", valign: "middle" });
  });

  // Details
  infoCard(s, 0.3, 2.38, 4.4, 2.05, "Timing & Presentation",
    "Onset: within 11 days of exchange Tx\nHeadache  •  Seizures\nAltered mental status  •  Hemiparesis\nObtundation requiring ventilatory support",
    ACCENT1, "0F2035");
  infoCard(s, 4.9, 2.38, 4.8, 2.05, "Pathophysiology & Management",
    "Abrupt ↑ haematocrit → ↓ cerebral blood flow\nVasoactive substances from penile detumescence\nAggressive treatment → complete recovery\nMonitor closely during/after RCE for priapism",
    ACCENT2, "0F2035");

  s.addText("Quick Compendium of Clinical Pathology, 5th ed. | Henry's Clinical Diagnosis & Management", {
    x: 0.3, y: 5.37, w: 9.4, h: 0.22, fontSize: 8.5, color: "5A7090", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – COMPLICATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Complications of Exchange Transfusion");
  slideTitle(s, "Procedural & Transfusion-Related Complications");

  infoCard(s, 0.3, 1.55, 4.5, 3.75, "Procedure-Related Complications",
    "• Emboli & thromboses (catheter-related)\n• Haemodynamic instability\n• Hypocalcaemia (citrate chelates Ca²⁺)\n• Coagulopathy (dilutional)\n• Infection (catheter sepsis)\n• Hypothermia (cold blood products)\n  → Use high-flow warming devices\n• Death (rare)\n\n⚠ Calcium supplementation needed when\ntransfusion rate > 100 mL/min",
    ACCENT1, CARD_BG);

  infoCard(s, 5.05, 1.55, 4.65, 3.75, "Transfusion-Related Complications",
    "• TA-GVHD — prevented by IRRADIATION\n  (>90% mortality if it occurs)\n\n• Alloimmunisation in SCD:\n  Overall rate: 19–47% (no matching)\n  Most common: anti-K, C, E, Fyᵃ, Jkᵇ\n  With Cc/D/Ee/Kell matching:\n  → Rate ↓ from 3% to 0.5%/unit\n\n• Delayed haemolytic Tx reaction\n• CMV transmission (use CMV-safe products)\n• Metabolic alkalosis post-transfusion\n  (citrate metabolism)",
    MID_BG, CARD_BG);

  s.addText("The Harriet Lane Handbook, 23rd ed. | Quick Compendium, 5th ed. | Henry's", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.2, fontSize: 8, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – ALLOIMMUNISATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Pathology Deep Dive — Alloimmunisation");
  slideTitle(s, "Alloimmunisation in Multiply Transfused SCD Patients");

  // Big stat boxes
  const stats = [
    { val: "19–47%", label: "Overall alloimmunisation\nrate WITHOUT\nphenotype matching", color: ACCENT1 },
    { val: "3%", label: "Per unit transfused\nrate before extended\nmatching", color: ACCENT3 },
    { val: "0.5%", label: "Per unit transfused\nrate WITH Cc/D/Ee/\nKell matching", color: ACCENT2 },
  ];
  stats.forEach((st, i) => {
    const xPos = 0.3 + i * 3.2;
    s.addShape(pres.ShapeType.rect, { x: xPos, y: 1.52, w: 3.0, h: 1.4, fill: { color: st.color } });
    s.addText(st.val, { x: xPos, y: 1.52, w: 3.0, h: 0.78, fontSize: 30, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(st.label, { x: xPos, y: 2.3, w: 3.0, h: 0.62, fontSize: 10.5, color: WHITE, align: "center", valign: "top", fontFace: "Calibri" });
  });

  // Common antibodies
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.1, w: 9.4, h: 2.15, fill: { color: CARD_BG }, line: { color: "D0D8E0" } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.1, w: 9.4, h: 0.38, fill: { color: MID_BG } });
  s.addText("Most Common Alloantibodies Formed in SCD", { x: 0.42, y: 3.12, w: 9.1, h: 0.34, fontSize: 11, bold: true, color: WHITE, valign: "middle", margin: 0 });

  const abs = ["Anti-K (Kell)", "Anti-C", "Anti-E", "Anti-Fyᵃ (Duffy a)", "Anti-Jkᵇ (Kidd b)"];
  abs.forEach((ab, i) => {
    const xPos = 0.5 + i * 1.84;
    s.addShape(pres.ShapeType.rect, { x: xPos, y: 3.6, w: 1.65, h: 0.7, fill: { color: i % 2 === 0 ? ACCENT1 : ACCENT2 } });
    s.addText(ab, { x: xPos, y: 3.6, w: 1.65, h: 0.7, fontSize: 10.5, bold: true, color: WHITE, align: "center", valign: "middle" });
  });

  s.addText("Clinical implications: Future crossmatch difficulties · Delayed haemolytic Tx reactions · HDFN in subsequent pregnancies", {
    x: 0.42, y: 4.42, w: 9.1, h: 0.75, fontSize: 11, color: TEXT_DARK, valign: "middle", fontFace: "Calibri", italic: true
  });

  s.addText("Quick Compendium of Clinical Pathology, 5th ed.", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.2, fontSize: 8, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – EVIDENCE BASE (STOP TRIALS + PUBMED)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Evidence Base — Clinical Trials & Recent Literature");
  slideTitle(s, "Key Evidence: STOP Trials & Current Guidelines");

  // STOP Trial
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.52, w: 9.4, h: 2.05, fill: { color: CARD_BG }, line: { color: "D0D8E0" } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.52, w: 9.4, h: 0.4, fill: { color: ACCENT1 } });
  s.addText("STOP & STOP II Trials (Adams et al., 1998 / 2005) — Chronic Transfusion for Stroke Prevention in SCD", {
    x: 0.42, y: 1.54, w: 9.1, h: 0.36, fontSize: 11, bold: true, color: WHITE, valign: "middle", margin: 0
  });
  s.addText([
    { text: "STOP: ", options: { bold: true, fontSize: 11.5, color: ACCENT1 } },
    { text: "130 high-risk children (abnormal TCD) → standard care vs chronic RBC transfusion. ", options: { fontSize: 11, color: TEXT_DARK } },
    { text: "11 strokes in control vs 1 in transfusion group", options: { bold: true, fontSize: 11, color: ACCENT1 } },
    { text: ". Trial halted early.  ", options: { fontSize: 11, color: TEXT_DARK } },
    { text: "STOP II: ", options: { bold: true, fontSize: 11.5, color: MID_BG } },
    { text: "Stopping transfusion → 14 reverted to high-risk TCD + 2 strokes. Mean time to event: 4.6 months. Trial halted early.", options: { fontSize: 11, color: TEXT_DARK } },
  ], { x: 0.42, y: 1.96, w: 9.1, h: 1.52, valign: "top", fontFace: "Calibri", lineSpacingMultiple: 1.25 });

  // Recent PubMed
  const refs = [
    { pmid: "36469119", title: "De Winter et al. 2023 (Eur J Pediatr)", body: "History & current standard of postnatal management in HDFN. Reviews ET vs IVIG outcomes — exchange still gold standard for severe cases." },
    { pmid: "39259272", title: "Chastain et al. 2024 (JAAPA)", body: "Updated guideline on neonatal hyperbilirubinemia management — phototherapy thresholds and escalation criteria to exchange transfusion." },
    { pmid: "40619190", title: "Wickremasinghe & Kuzniewicz 2025 (Pediatr Clin N Am)", body: "Latest 2025 evidence on neonatal hyperbilirubinemia — exchange threshold updates, risk stratification, clinical decision tools." },
  ];
  refs.forEach((r, i) => {
    const yPos = 3.72 + i * 0.57;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: yPos, w: 9.4, h: 0.52, fill: { color: i % 2 === 0 ? WHITE : CARD_BG }, line: { color: "D0D8E0", width: 0.5 } });
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: yPos, w: 1.1, h: 0.52, fill: { color: ACCENT2 } });
    s.addText("PMID\n" + r.pmid, { x: 0.3, y: yPos, w: 1.1, h: 0.52, fontSize: 8, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(r.title + ": " + r.body, { x: 1.48, y: yPos + 0.05, w: 8.1, h: 0.42, fontSize: 10, color: TEXT_DARK, valign: "middle", fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – SUMMARY TABLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionBanner(s, "Summary");
  slideTitle(s, "Exchange Transfusion: Quick Reference Summary");

  const headers = ["Indication", "Pathological Basis", "Key Threshold / Goal"];
  const rows = [
    ["Neonatal Hyperbilirubinaemia", "Unconjugated bilirubin neurotoxicity → kernicterus", "TSB >25 mg/dL; immediate if encephalopathy signs"],
    ["HDFN", "Maternal IgG-mediated RBC haemolysis", "Positive DAT + rising bilirubin + anaemia"],
    ["SCD — Stroke", "HbS vaso-occlusion → cerebral infarction", "Urgent exchange; target HbS <30%"],
    ["SCD — Acute Chest Syndrome", "Pulmonary sickling + infection → hypoxia", "Worsening hypoxia on Rx; RCE preferred"],
    ["SCD — Priapism (fulminant)", "Penile vaso-occlusion (>6 hrs)", "Failed medical Rx; monitor for ASPEN"],
    ["Babesiosis (severe)", "High parasitaemia — infected RBCs", "Clindamycin + quinine + exchange"],
    ["Polycythaemia neonatorum", "Hyperviscosity → end-organ ischaemia", "Venous Hct >65%"],
  ];

  const colW = [3.0, 3.5, 3.1];
  const colX = [0.25, 3.25, 6.75];
  const rH = 0.52;
  const tY = 1.65;

  headers.forEach((h, ci) => {
    s.addShape(pres.ShapeType.rect, { x: colX[ci], y: tY, w: colW[ci], h: 0.44, fill: { color: DARK_BG } });
    s.addText(h, { x: colX[ci] + 0.08, y: tY, w: colW[ci] - 0.1, h: 0.44, fontSize: 11, bold: true, color: WHITE, valign: "middle", align: "center" });
  });
  rows.forEach((row, ri) => {
    const yRow = tY + 0.44 + ri * rH;
    const bg = ri % 2 === 0 ? WHITE : CARD_BG;
    const leftAccent = [ACCENT1, ACCENT2, MID_BG, ACCENT3, ACCENT1, "7B68EE", ACCENT2][ri];
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: colX[ci], y: yRow, w: colW[ci], h: rH, fill: { color: bg }, line: { color: "D0D8E0", width: 0.5 } });
      if (ci === 0) {
        s.addShape(pres.ShapeType.rect, { x: colX[ci], y: yRow, w: 0.18, h: rH, fill: { color: leftAccent } });
      }
      s.addText(cell, { x: colX[ci] + (ci === 0 ? 0.25 : 0.1), y: yRow, w: colW[ci] - (ci === 0 ? 0.3 : 0.15), h: rH, fontSize: 10, color: TEXT_DARK, valign: "middle", fontFace: "Calibri", bold: ci === 0 });
    });
  });

  s.addText("Sources: Quick Compendium 5th ed. · Henry's Clinical Diagnosis · Harriet Lane 23rd ed. · Goldman-Cecil · Harrison's 22E · Harriet Lane", {
    x: 0.3, y: 5.36, w: 9.4, h: 0.24, fontSize: 8.5, color: "888888", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 – REFERENCES & CLOSE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: ACCENT1 } });
  s.addText("REFERENCES", { x: 0.3, y: 0.03, w: 9.4, h: 0.5, fontSize: 11, bold: true, color: WHITE, charSpacing: 3, valign: "middle", margin: 0 });

  s.addText("Textbooks", { x: 0.4, y: 0.65, w: 9.0, h: 0.4, fontSize: 14, bold: true, color: ACCENT2, valign: "middle" });

  const refs = [
    "Quick Compendium of Clinical Pathology, 5th ed. — Sections 2.3.1.2–2.3.1.3, 2.5.1.1",
    "Henry's Clinical Diagnosis and Management by Laboratory Methods — Neonatal Transfusion & RCE in SCD",
    "The Harriet Lane Handbook, 23rd ed. (Johns Hopkins Hospital) — Chapter 18",
    "Goldman-Cecil Medicine International Edition — SCD Management of Surgery & Stroke",
    "Harrison's Principles of Internal Medicine, 22nd ed. (2025) — Bilirubin Metabolism",
    "Medical Microbiology, 9th ed. — Babesiosis treatment",
    "Roberts & Hedges' Clinical Procedures in Emergency Medicine — Heavy Metal Poisoning",
    "Bradley & Daroff's Neurology in Clinical Practice — Kernicterus & BIND",
  ];
  refs.forEach((r, i) => {
    s.addText("• " + r, {
      x: 0.45, y: 1.1 + i * 0.36, w: 9.1, h: 0.36,
      fontSize: 10.5, color: TEXT_LIGHT, valign: "middle", fontFace: "Calibri"
    });
  });

  s.addText("Journal Articles", { x: 0.4, y: 4.03, w: 9.0, h: 0.35, fontSize: 13, bold: true, color: ACCENT2 });
  const jRefs = [
    "De Winter DP et al. Eur J Pediatr. 2023 Feb. PMID: 36469119",
    "Chastain AP et al. JAAPA. 2024 Oct. PMID: 39259272",
    "Wickremasinghe AC & Kuzniewicz MW. Pediatr Clin N Am. 2025 Aug. PMID: 40619190",
    "Adams RJ et al. STOP Trial. N Engl J Med. 1998 | Adams & Brambilla. STOP II. 2005",
  ];
  jRefs.forEach((r, i) => {
    s.addText("• " + r, {
      x: 0.45, y: 4.42 + i * 0.3, w: 9.1, h: 0.28,
      fontSize: 10, color: ACCENT2, valign: "middle", fontFace: "Calibri"
    });
  });
}

// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/exchange-transfusion-ppt/Exchange_Transfusion_Pathology.pptx" })
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pres.author = "Orris Medical";
pres.title = "Platelet Apheresis: Pathological Basis and Clinical Integration";

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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════════════════════════════════
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  s.addText("PLATELET APHERESIS", {
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    color:"7090AA", fontFace:"Calibri", italic:true
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  s.addText("Sources: Quick Compendium 5th ed. · Henry's · Goldman-Cecil · Tietz · Harriet Lane · Harrison's 22E", {
    x:0.2, y:4.8, w:9.6, h:0.52, fontSize:9, color:WHITE, align:"center", valign:"middle"
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — DEFINITION & OVERVIEW
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Definition & Overview");
  sTitle(s, "What is Platelet Apheresis?");

  // definition box
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    "Donor platelets collected by apheresis machine\nSingle-donor apheresis platelets (SDP)\nAlso called: plateletpheresis\nOne collection = equivalent of ~6 whole-blood-\nderived platelet units (≥3.0 × 10¹¹ platelets)\nUsed as a therapeutic blood product for\npatients with thrombocytopenia", ACCENT2, 11);

  card(s, 5.05, 2.52, 4.55, 2.85, "Role 2 — Therapeutic Removal",
    "Therapeutic thrombocytapheresis\nPatient's excess platelets removed\nIndicates: symptomatic thrombocytosis\n  (essential thrombocythaemia, CML,\n   polycythaemia vera, etc.)\nTemporary measure while cytoreductive\ntherapy takes effect (hours to days)", ACCENT1, 11);

  refBar(s, "Quick Compendium of Clinical Pathology 5th ed. | Henry's Clinical Diagnosis & Management | Goldman-Cecil Medicine");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — APHERESIS PLATELET PRODUCT: PREPARATION & SPECIFICATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Blood Product — Apheresis Platelets: Preparation & Specifications");
  sTitle(s, "Apheresis Platelet Product: What's Inside?");

  // vs table – apheresis vs whole blood derived
  const hdr = ["Parameter", "Apheresis Platelet (SDP)", "Whole-Blood Platelet Concentrate"];
  const rows = [
    ["Platelet content", "≥3.0 × 10¹¹ (min 90% of units)", "~0.55 × 10¹¹ per unit"],
    ["Equivalent dose", "= 1 therapeutic dose (alone)", "~5–6 units pooled needed"],
    ["Volume", "~100 mL (incl. plasma)", "~50 mL per unit"],
    ["Fibrinogen", "~150 mg", "~80 mg"],
    ["Leukocytes (LR)", "<5.0 × 10⁶ WBC", "<8.3 × 10⁵ WBC (LR)"],
    ["Donor exposures", "1 donor per dose", "5–6 donors per dose"],
    ["Shelf life", "5 days (closed system)", "5 days; 4 hrs after pooling"],
    ["pH requirement", "≥6.2 (≥90% units)", "≥6.2 (≥90% units)"],
  ];

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  const tY = 1.5;

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  refBar(s, "Quick Compendium of Clinical Pathology 5th ed. | Henry's Clinical Diagnosis & Management | Goldman-Cecil Medicine");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — DONOR SELECTION & COLLECTION PROCESS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Donor Selection & Collection Process");
  sTitle(s, "Plateletapheresis Donor Criteria & Collection");

  card(s, 0.3, 1.5, 4.65, 2.55, "Donor Eligibility Criteria",
    "Same base requirements as whole-blood donation\nMinimum pre-donation platelet count: ≥150,000/μL\nDefer if aspirin/piroxicam within 2 days of donation\nClopidogrel / ticlopidine: defer 14 days after last dose\nThienopyridines assessed individually\n\"Medications causing irreversible platelet inhibition\"\nmust be evaluated before donation (AABB Standards)", ACCENT1, 11);

  card(s, 5.15, 1.5, 4.55, 2.55, "Donation Frequency Limits",
    "Maximum: twice per week\nMinimum interval: 2 days between procedures\nMaximum: 24 times per year\nMaximum: 2 apheresis procedures in 7 days\nTotal platelet loss cannot exceed:\n  24 × 10¹¹ platelets per 7-day period\nFDA + AABB Standards govern all limits", ACCENT2, 11);

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  refBar(s, "Henry's Clinical Diagnosis & Management | AABB Standards | FDA Guidance (2007)");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — PRODUCT VARIANTS & MODIFICATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Product Variants & Modifications");
  sTitle(s, "Types of Apheresis Platelet Products");

  const variants = [
    { title:"Standard Apheresis Platelet", body:"≥3.0 × 10¹¹ platelets\nVolume ~100 mL + plasma\nIncludes WBCs (<5×10⁶)\nStored 20–24°C with agitation\nShelf life: 5 days", color:ACCENT2 },
    { title:"Leukoreduced Apheresis Platelet", body:"Residual WBC <5 × 10⁶\nPrestorage leukoreduction preferred\n(better quality control)\nReduces HLA alloimmunisation\nReduces febrile reactions & CMV", color:ACCENT1 },
    { title:"Platelet Additive Solution (PAS) Added", body:"Replaces portion of donor plasma\nwith approved additive solution\nReduces plasma volume\nDecreases isohemagglutinin titres\nLower risk of allergic reactions\n& ABO-incompatible plasma reactions", color:ACCENT3 },
    { title:"Pathogen-Reduced Platelets", body:"Nucleic acid inactivation technology\nInactivates viruses, bacteria, parasites\nPrevents donor lymphocyte replication\n→ NO irradiation required (replaces it)\nDecreased TA-GVHD risk\nUsed preferentially in Europe", color:ACCENT4 },
    { title:"Irradiated Apheresis Platelets", body:"Gamma or X-ray irradiation\n25 Gy midplane dose (min 15 Gy)\nPrevents TA-GVHD in\nimmunocompromised recipients\nRequired for: BMT, haematologic\nmalignancy, neonates receiving IUT", color:MID_BG },
    { title:"Cold-Stored Platelets (Emerging)", body:"Stored at 1–6°C\nApproved in US (2020s)\nShelf life: up to 14 days\nShorter in-vivo lifespan (<24h)\nbut better haemostatic function\nUsed in trauma/massive bleeding", color:"2E86AB" },
  ];

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  refBar(s, "Quick Compendium 5th ed. | Henry's | Goldman-Cecil Medicine | Tietz Textbook of Laboratory Medicine 7th ed.");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — STORAGE, HANDLING & QUALITY CONTROL
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Storage, Handling & Quality Control");
  sTitle(s, "Storage Conditions, Expiry & QC Standards");

  card(s, 0.3, 1.5, 4.55, 3.9, "Storage & Handling",
    "Temperature: 20–24°C with CONTINUOUS gentle agitation\nWhy agitation? Prevents platelet aggregation, maintains pH\nTransport: agitation not required if <24 hours\nExpiry: 5 days from collection\n  (FDA allows up to 7 days with bacterial testing)\nIf system opened (pooled): expires in 4 hours\nBacterial contamination screening MANDATORY\n  (prevents septic transfusion reactions)\nDo NOT refrigerate (causes irreversible\n  platelet activation/shape change)", ACCENT1, 10.5);

  card(s, 5.05, 1.5, 4.55, 3.9, "Quality Control (QC) Standards",
    "Platelet count: ≥3.0 × 10¹¹ in ≥90% units (AABB)\n  FDA: ≥3.0 × 10¹¹ in ≥75% units\npH: ≥6.2 in ≥90% of units tested\n  (low pH = platelet swirling loss = dysfunction)\nLeukocyte count (if LR): <5 × 10⁶ WBC\nVolume: ~100 mL per unit\nSwirling test: visual quality indicator\n  (disc-shaped platelets reflect light → swirling)\nBacterial contamination: tested by culture\n  or rapid detection methods\nFibrinogen content: ~150 mg per unit", ACCENT2, 10.5);

  refBar(s, "Quick Compendium of Clinical Pathology 5th ed. | AABB Standards | Henry's | Goldman-Cecil Medicine");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — INDICATIONS FOR PLATELET TRANSFUSION (USING APHERESIS PLATELETS)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Indications — Platelet Transfusion using Apheresis Platelets");
  sTitle(s, "When to Transfuse Apheresis Platelets? (Medicine Integration)");

  const cols = [
    {
      title:"Prophylactic (Non-Bleeding)", color:MID_BG,
      items:[
        "Threshold: <10,000/μL (general)",
        "  (no fever, sepsis, coagulopathy,",
        "  hypersplenism, bleeding risk lesions)",
        "Preoperative (non-neurosurgical):",
        "  target ≥50,000/μL",
        "Preoperative (neurosurgical):",
        "  target ≥100,000/μL",
        "Chemotherapy-induced thrombocytopenia",
        "Bone marrow failure states",
        "Aplastic anaemia",
      ]
    },
    {
      title:"Therapeutic (Active Bleeding)", color:ACCENT1,
      items:[
        "Platelet count <50,000/μL for",
        "  extracranial bleeds",
        "Platelet count <100,000/μL for",
        "  intracranial haemorrhage",
        "Massive transfusion protocols",
        "DIC with active haemorrhage",
        "Trauma (goal-directed therapy)",
        "Pre-procedure (e.g. lumbar puncture,",
        "  liver biopsy, central line insertion)",
      ]
    },
    {
      title:"Functional Platelet Defects", color:ACCENT2,
      items:[
        "Glanzmann thrombasthenia",
        "  (GPIIb/IIIa deficiency)",
        "Bernard-Soulier syndrome",
        "  (GPIb deficiency)",
        "Aspirin / NSAID ingestion",
        "  (irreversible COX inhibition)",
        "Uraemic platelet dysfunction",
        "  (try DDAVP / cryoprecipitate first)",
        "Storage pool disorders",
      ]
    },
  ];

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  refBar(s, "Quick Compendium 5th ed. | Henry's | Tintinalli's Emergency Medicine | Washington Manual of Medical Therapeutics");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — CONTRAINDICATIONS & PLATELET REFRACTORINESS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Contraindications & Platelet Refractoriness");
  sTitle(s, "When NOT to Transfuse & Platelet Refractoriness");

  card(s, 0.3, 1.5, 4.55, 1.75, "Contraindications to Platelet Transfusion",
    "ABSOLUTE:\n  • TTP (thrombotic thrombocytopaenic purpura)\n  • HIT (heparin-induced thrombocytopaenia)\n    → Platelet transfusion may be DELETERIOUS\n    → Worsens thrombotic complications\nRELATIVE: ITP (immune thrombocytopaenia)\n  → platelets destroyed rapidly", ACCENT1, 10.5);

  // Refractoriness - large section
  s.addShape(pres.ShapeType.rect, { x:0.3, y:3.38, w:4.55, h:2.05, fill:{color:CARD_BG}, line:{color:"D0D8E0"} });
  s.addShape(pres.ShapeType.rect, { x:0.3, y:3.38, w:4.55, h:0.37, fill:{color:MID_BG} });
  s.addText("Corrected Count Increment (CCI) — Refractoriness Assessment", { x:0.4, y:3.4, w:4.35, h:0.33, fontSize:9.5, bold:true, color:WHITE, valign:"middle", margin:0 });
  s.addText("CCI = (Post-Pre platelet count) × BSA (m²) ÷ No. platelets transfused (×10¹¹)\n\nNormal response: CCI >7500 at 1-hour\nRefractory: CCI <5000 on TWO occasions\n\nCauses of refractoriness:\n  Non-immune: fever, sepsis, splenomegaly, DIC, drugs\n  Immune: HLA alloimmunisation, HPA antibodies",
    { x:0.42, y:3.8, w:4.3, h:1.55, fontSize:10, color:TEXT_DARK, valign:"top", fontFace:"Calibri", lineSpacingMultiple:1.2 });

  card(s, 5.05, 1.5, 4.55, 3.93, "Managing Refractory Patients with Apheresis Platelets",
    "HLA-MATCHED apheresis platelets:\n  → Key intervention for immune refractoriness\n  → Match donor HLA class I (A, B) with recipient\n  → Most effective strategy\n\nCROSSMATCHED platelets:\n  → Platelet crossmatch to find compatible unit\n  → Useful when HLA-matched unavailable\n\nABO-COMPATIBLE platelets:\n  → ABO-compatible plasma in apheresis unit\n    reduces haemolytic reactions\n\nPlatelet antibody screen / HLA antibody testing:\n  → Identifies immune cause\n  → Guides matched product selection\n\nIVIG: may temporarily suppress antibody-\n  mediated destruction", ACCENT2, 10.5);

  refBar(s, "Quick Compendium 5th ed. | Henry's | Goldman-Cecil Medicine | Barash Clinical Anesthesia 9e | PMID 36535829");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — ADVANTAGES OF APHERESIS OVER POOLED PLATELETS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Advantages of Apheresis Platelets over Pooled (Random Donor) Platelets");
  sTitle(s, "Why Apheresis Platelets? — Key Advantages");

  const advantages = [
    { num:"01", title:"Reduced Donor Exposure", body:"1 donor vs 5–6 donors per dose\n→ Decreases risk of transfusion-\ntransmitted infections (HIV, HCV, etc.)\n→ Delays HLA alloimmunisation", color:ACCENT1 },
    { num:"02", title:"Lower Alloimmunisation Risk", body:"Fewer HLA antigens encountered\nTRAP Study (1997): prestorage LR\napheresis platelets significantly\ndelayed HLA alloimmunisation\nvs. pooled non-LR products", color:ACCENT2 },
    { num:"03", title:"Reduced Febrile Reactions", body:"Prestorage leukoreduction\nremoves WBCs before cytokine\naccumulation during storage\n→ Fewer febrile non-haemolytic\ntransfusion reactions (FNHTRs)", color:ACCENT3 },
    { num:"04", title:"Decreased CMV Transmission", body:"Prestorage LR apheresis platelets\nare CMV risk-reduced\n(Bowden et al., 1995)\nEquivalent to seronegative products\nfor CMV-at-risk patients", color:ACCENT4 },
    { num:"05", title:"Less Septic Reactions", body:"Single donor collection =\nfewer bacterial contamination\nexposure opportunities\n(Ness et al., 2001)\nBacterial screening still required", color:MID_BG },
    { num:"06", title:"Inventory Advantage", body:"No pooling needed → maintains\nclosed system → full 5-day shelf life\nPrevents 4-hour expiry clock\nReduces product wastage\nSimplifies blood bank inventory\nmanagement", color:"2E86AB" },
  ];

  advantages.forEach((a, i) => {
    const col = i%3; const row = Math.floor(i/3);
    const xP = 0.28 + col*3.22;
    const yP = 1.52 + row*1.92;
    s.addShape(pres.ShapeType.rect, { x:xP, y:yP, w:3.06, h:1.77, fill:{color:CARD_BG}, line:{color:"D0D8E0"} });
    s.addShape(pres.ShapeType.ellipse, { x:xP+0.08, y:yP+0.08, w:0.72, h:0.72, fill:{color:a.color} });
    s.addText(a.num, { x:xP+0.08, y:yP+0.08, w:0.72, h:0.72, fontSize:16, bold:true, color:WHITE, align:"center", valign:"middle" });
    s.addText(a.title, { x:xP+0.9, y:yP+0.12, w:2.1, h:0.62, fontSize:11, bold:true, color:a.color, valign:"middle" });
    s.addText(a.body, { x:xP+0.1, y:yP+0.88, w:2.88, h:0.82, fontSize:9.5, color:TEXT_DARK, valign:"top", fontFace:"Calibri", lineSpacingMultiple:1.15 });
  });

  refBar(s, "Henry's Clinical Diagnosis & Management | TRAP Study (1997) | Sintnicolaas 1981 | Ness 2001 | Bowden 1995");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — THERAPEUTIC THROMBOCYTAPHERESIS (REMOVAL)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Therapeutic Thrombocytapheresis — Platelet Removal");
  sTitle(s, "Therapeutic Thrombocytapheresis: Indications & Pathology");

  // Pathology box
  s.addShape(pres.ShapeType.rect, { x:0.3, y:1.5, w:9.4, h:0.82, fill:{color:MID_BG} });
  s.addText("Pathological Basis: Thrombocytosis", { x:0.45, y:1.52, w:3.5, h:0.3, fontSize:11, bold:true, color:ACCENT2 });
  s.addText([
    { text:"Primary thrombocytosis (ET, CML, PCV, agnogenic myeloid metaplasia): ", options:{bold:true, fontSize:11, color:ACCENT3} },
    { text:"Thromboembolic events in 56% vs 4% in reactive disease (Buss et al., 1994)  |  ", options:{fontSize:11, color:WHITE} },
    { text:"Platelet count >2,000,000 → paradoxical bleeding (acquired vWD)  |  JAK2 mutation → thrombosis risk", options:{bold:true, fontSize:11, color:ACCENT2} },
  ], { x:0.45, y:1.82, w:9.1, h:0.44, valign:"top", fontFace:"Calibri" });

  // Indications two cols
  card(s, 0.3, 2.48, 4.55, 2.28, "ASFA Indications for Thrombocytapheresis",
    "SYMPTOMATIC thrombocytosis:\n  ASFA Category II, Grade 2C recommendation\n  → Stroke, TIA, erythromelalgia, microvascular\n    occlusion, acute MI, priapism\n  → Active haemorrhage (platelet count >2M)\n\nPROPHYLACTIC (asymptomatic thrombocytosis):\n  ASFA Category III, Grade 2C\n  → Not routine; individualised decision", ACCENT1, 10.5);

  card(s, 5.05, 2.48, 4.55, 2.28, "Underlying Diseases Requiring Thrombocytapheresis",
    "Essential Thrombocythaemia (ET)\n  → JAK2 V617F mutation in ~50%\nPolycythaemia Vera (PV)\nChronic Myeloid Leukaemia (CML)\nAgnogenic Myeloid Metaplasia / MF\nReactive thrombocytosis:\n  → Rare indication (thromboembolic risk low)\n  → Only if symptoms present", ACCENT2, 10.5);

  // Important caveat bar
  s.addShape(pres.ShapeType.rect, { x:0.3, y:4.9, w:9.4, h:0.42, fill:{color:"FFF3E0"}, line:{color:ACCENT3} });
  s.addText("⚠ KEY LIMITATION: Effects of thrombocytapheresis are TEMPORARY (lasting only hours to days). Medical / cytoreductive therapy (hydroxyurea, anagrelide, interferon) MUST be instituted concurrently.", {
    x:0.42, y:4.91, w:9.1, h:0.4, fontSize:10, color:TEXT_DARK, valign:"middle", fontFace:"Calibri"
  });

  refBar(s, "Henry's Clinical Diagnosis & Management | ASFA Guidelines (Padmanabhan et al., 2019) | Quick Compendium 5th ed. | Buss et al. 1994");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — THROMBOCYTOSIS: PRIMARY vs SECONDARY (PATHOLOGY DEEP DIVE)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Pathology Deep Dive — Thrombocytosis Classification");
  sTitle(s, "Primary vs Secondary Thrombocytosis: Clinical Relevance");

  // Stats highlight
  s.addShape(pres.ShapeType.rect, { x:0.3, y:1.5, w:9.4, h:0.68, fill:{color:CARD_BG}, line:{color:"D0D8E0"} });
  s.addText([
    { text:"Secondary (Reactive) thrombocytosis accounts for ", options:{fontSize:12, color:TEXT_DARK} },
    { text:">85%", options:{bold:true, fontSize:15, color:ACCENT1} },
    { text:" of all thrombocytosis cases. Thromboembolic risk in reactive = ", options:{fontSize:12, color:TEXT_DARK} },
    { text:"4%", options:{bold:true, fontSize:15, color:ACCENT2} },
    { text:" vs Essential (primary) = ", options:{fontSize:12, color:TEXT_DARK} },
    { text:"56%", options:{bold:true, fontSize:15, color:ACCENT1} },
    { text:"  (Buss et al., 1994)", options:{fontSize:11, color:"888888", italic:true} },
  ], { x:0.45, y:1.52, w:9.1, h:0.64, valign:"middle", fontFace:"Calibri" });

  // Two columns
  card(s, 0.3, 2.35, 4.55, 2.88, "Primary Thrombocytosis",
    "Essential Thrombocythaemia (ET)\n  → JAK2 V617F ~50%, CALR ~25%\nPolycythaemia Vera (PV)\nChronic Myeloid Leukaemia (CML)\nAgnogenic Myeloid Metaplasia / MF\n\nComplications:\n  • Arterial > venous thrombosis\n  • Erythromelalgia (microvascular)\n  • Cerebral sinus thrombosis\n  • Platelet count >2M → acquired vWD\n    → BLEEDING (not thrombosis!)\n\nTreatment: cytoreduction + aspirin\n  ± thrombocytapheresis (bridge)", ACCENT1, 10);

  card(s, 5.05, 2.35, 4.55, 2.88, "Secondary (Reactive) Thrombocytosis",
    "Causes:\n  • Splenectomy (most dramatic rise)\n  • Acute haemorrhage / iron deficiency\n  • Chronic inflammatory diseases\n  • Solid malignancies\n  • Rebound after myelosuppression\n  • Infections / post-operative\n\nRisk: Low thromboembolic risk unless\n  underlying malignancy or atherosclerosis\n\nManagement:\n  Treat underlying cause\n  Thrombocytapheresis: ONLY if symptomatic\n  (ASFA Category III for asymptomatic RT)", ACCENT2, 10);

  refBar(s, "Henry's Clinical Diagnosis & Management | Quick Compendium 5th ed. | ASFA Guidelines 2019 | Sulai & Tefferi 2012");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — LEUKOREDUCTION & HLA ALLOIMMUNISATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color:"080F1C" };

  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.52, fill:{color:ACCENT1} });
  s.addText("PATHOLOGY FOCUS — LEUKOREDUCTION & HLA ALLOIMMUNISATION", {
    x:0.3, y:0.03, w:9.4, h:0.47, fontSize:9.5, bold:true, color:WHITE, charSpacing:2, valign:"middle", margin:0
  });
  s.addText("Leukoreduction of Apheresis Platelets: Preventing HLA Alloimmunisation", {
    x:0.4, y:0.58, w:9.2, h:0.65, fontSize:21, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle"
  });
  s.addShape(pres.ShapeType.rect, { x:0.4, y:1.22, w:1.0, h:0.05, fill:{color:ACCENT2} });

  // Mechanism card
  const mech = [
    {label:"Step 1", txt:"WBCs in non-LR platelets present HLA class I antigens to recipient T-cells", color:ACCENT1},
    {label:"Step 2", txt:"CD4+ T-cells activated → B-cell stimulation → anti-HLA class I antibody production", color:ACCENT3},
    {label:"Step 3", txt:"Anti-HLA antibodies bind transfused platelets → complement activation / phagocytosis → platelet destruction", color:ACCENT4},
    {label:"Result", txt:"PLATELET REFRACTORINESS — further transfusions fail to increment platelet count (CCI <5000)", color:ACCENT2},
  ];
  mech.forEach((m, i) => {
    const yP = 1.38 + i*0.86;
    s.addShape(pres.ShapeType.rect, { x:0.3, y:yP, w:1.4, h:0.72, fill:{color:m.color} });
    s.addText(m.label, { x:0.3, y:yP, w:1.4, h:0.72, fontSize:13, bold:true, color:WHITE, align:"center", valign:"middle" });
    s.addShape(pres.ShapeType.rect, { x:1.7, y:yP, w:5.5, h:0.72, fill:{color:"0F1E35"}, line:{color:"2A4070"} });
    s.addText(m.txt, { x:1.82, y:yP, w:5.3, h:0.72, fontSize:11, color:TEXT_LITE, valign:"middle", fontFace:"Calibri" });
  });

  // Prevention card
  s.addShape(pres.ShapeType.rect, { x:7.45, y:1.38, w:2.3, h:3.44, fill:{color:"0F2035"}, line:{color:"2A4070"} });
  s.addShape(pres.ShapeType.rect, { x:7.45, y:1.38, w:2.3, h:0.38, fill:{color:ACCENT2} });
  s.addText("Prevention", { x:7.52, y:1.4, w:2.15, h:0.34, fontSize:11, bold:true, color:WHITE, valign:"middle", margin:0 });
  s.addText("• Prestorage leukoreduction\n  (preferred)\n• Bedside LR less effective\n• TRAP Study (1997):\n  LR apheresis platelets\n  delayed alloimmunisation\n  vs. non-LR pooled\n• HLA-matched apheresis\n  platelets for refractory\n  patients", { x:7.55, y:1.82, w:2.1, h:2.88, fontSize:10, color:TEXT_LITE, valign:"top", fontFace:"Calibri", lineSpacingMultiple:1.22 });

  refBar(s, "Quick Compendium 5th ed. | Tietz 7th ed. | Henry's | TRAP Study Group 1997 | Tong et al. Transfus Apher Sci 2026 (PMID 41435793)");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — COMPLICATIONS OF PLATELET APHERESIS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Complications");
  sTitle(s, "Complications of Platelet Apheresis (Donation & Transfusion)");

  card(s, 0.3, 1.5, 4.55, 3.85, "Donor/Collection Complications",
    "Citrate toxicity (most common):\n  → Citrate anticoagulant chelates Ca²⁺\n  → Symptoms: perioral tingling, tetany,\n    nausea, cardiac arrhythmia\n  → Managed with oral/IV calcium\nVasovagal reactions:\n  → Lightheadedness, syncope\nHaematoma at venipuncture site\nThrombocytopenia in donor:\n  → Transient post-donation platelet drop\n  → Minimum pre-donation count: 150K/μL\nHypotension / fluid shift\nAir embolism (rare, machine-related)\nRepeat donation fatigue:\n  → Max 24 donations/year to protect donor\nLinear platelet count decrease\n  with frequent donation (RBC loss also)", ACCENT1, 10.5);

  card(s, 5.05, 1.5, 4.55, 3.85, "Recipient/Transfusion Complications",
    "Septic transfusion reaction:\n  → Platelet bacterial contamination\n  → Most common fatal TTI\n  → Staphylococcus, Gram-negatives\nFebrile non-haemolytic reactions (FNHTR):\n  → Cytokines from stored WBCs\n  → Reduced by prestorage LR\nAllergic reactions:\n  → Plasma proteins in product\n  → Reduced by PAS (additive solution)\nTA-GVHD:\n  → Donor lymphocytes engraft\n  → >90% mortality; prevented by\n    irradiation or pathogen reduction\nABO incompatibility:\n  → From plasma in unit with high-titer\n    isohemagglutinins\nTRALI (uncommon with male-only donors)\nPlatelet refractoriness (alloimmune)\nRBC contamination reactions\n  (if unit visibly bloody → crossmatch first)", ACCENT2, 10);

  refBar(s, "Quick Compendium 5th ed. | Henry's | Goldman-Cecil Medicine | Tietz 7th ed.");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — ABO COMPATIBILITY & SPECIAL CONSIDERATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "ABO Compatibility, Crossmatching & Special Populations");
  sTitle(s, "ABO, Crossmatching & Special Circumstances");

  card(s, 0.3, 1.5, 4.55, 2.15, "ABO Compatibility",
    "Platelets NOT routinely crossmatched\nException: unit contains >2 mL RBCs\n  (visibly bloody units)\nDesirable: plasma in unit compatible\n  with recipient's RBCs\nHigh-risk situations for ABO mismatch:\n  • Infants / small blood volumes\n  • Multiply transfused recipients\n  • Units with HIGH-TITER isohemagglutinins\n    (anti-A/B from Group O donors)", ACCENT1, 10.5);

  card(s, 5.05, 1.5, 4.55, 2.15, "Crossmatching Platelets",
    "NOT required unless >2 mL RBCs present\nPlatelet crossmatch used in:\n  → Refractory patients (immune cause)\n  → Finding HPA/HLA compatible unit\n  → When HLA-matched unavailable\nMethods: solid-phase, flow cytometry\nRecent study: combination of platelet\n  antibody screen + HLA testing most\n  effective (Chapman et al. 2023\n  PMID 36535829)", ACCENT2, 10.5);

  card(s, 0.3, 3.82, 4.55, 1.58, "Special Populations",
    "Neonates: 10–15 mL/kg or 1 unit/10 kg\n  → Irradiated + CMV-safe units required\n  → LR units preferred\nPregnancy-related thrombocytopenia:\n  → Avoid if platelet consumption (preeclampsia)\n  → Platelet transfusion <20–30K to facilitate delivery\nImmunocompromised (BMT, haematological\nmalignancy): ALWAYS irradiate", ACCENT3, 10.5);

  card(s, 5.05, 3.82, 4.55, 1.58, "Dosing Summary",
    "Adults: 4–6 pooled RDP OR 1 apheresis unit (SDP)\nExpected increment (1 apheresis unit): +30,000–60,000/μL\nExpected increment (1 random unit ~5.5×10¹⁰): ~5,000/μL\nAverage platelet lifespan: 9.5 days\nFilter: ≥170 μm (same as RBCs)\nNeonates: 10–15 mL/kg or 1 unit/10 kg", MID_BG, 10.5);

  refBar(s, "Quick Compendium 5th ed. | Henry's | Harriet Lane 23rd ed. | Chapman et al. PMID 36535829 | Comprehensive Clinical Nephrology 7th ed.");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — RECENT EVIDENCE & EMERGING CONCEPTS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Recent Evidence & Emerging Concepts");
  sTitle(s, "Current Evidence Base & Future Directions");

  const refs = [
    { pmid:"41650546", year:"2026", journal:"Transfus Apher Sci", title:"Frontier et al. — Lowering US minimum plateletpheresis yield?", body:"Reviews whether lowering the minimum yield threshold from 3.0×10¹¹ could reduce donor burden, increase collection frequency, and address supply shortages while maintaining clinical efficacy.", color:ACCENT1 },
    { pmid:"38962593", year:"2024", journal:"Cureus", title:"Ashok et al. — Impact of plateletpheresis on Hb, Hct, RBC count (Meta-analysis)", body:"Updated meta-analysis: plateletpheresis causes measurable decreases in haemoglobin, haematocrit, and total RBC count in donors — important for donor safety monitoring.", color:ACCENT2 },
    { pmid:"41435793", year:"2026", journal:"Transfus Apher Sci", title:"Tong et al. — Case for universal leukoreduction of blood transfusions", body:"Reviews evidence supporting universal LR policy including apheresis platelets — reduced alloimmunisation, CMV, FNHTR rates across all populations.", color:ACCENT3 },
    { pmid:"37550092", year:"2023", journal:"Transfus Apher Sci", title:"Raza et al. — Therapeutic plasma exchange in alloimmune platelet refractoriness", body:"Case series demonstrating plasma exchange as a rescue strategy for severe alloimmune refractoriness when HLA-matched apheresis platelets unavailable.", color:ACCENT4 },
  ];

  refs.forEach((r, i) => {
    const yP = 1.5 + i*0.95;
    s.addShape(pres.ShapeType.rect, { x:0.3, y:yP, w:9.4, h:0.87, fill:{color: i%2===0 ? WHITE : CARD_BG}, line:{color:"D0D8E0",width:0.5} });
    s.addShape(pres.ShapeType.rect, { x:0.3, y:yP, w:1.45, h:0.87, fill:{color:r.color} });
    s.addText("PMID\n"+r.pmid+"\n"+r.year, { x:0.3, y:yP, w:1.45, h:0.87, fontSize:8.5, bold:true, color:WHITE, align:"center", valign:"middle" });
    s.addText(r.title+" — "+r.journal, { x:1.85, y:yP+0.05, w:7.7, h:0.32, fontSize:10.5, bold:true, color:r.color, valign:"middle" });
    s.addText(r.body, { x:1.85, y:yP+0.38, w:7.7, h:0.44, fontSize:10, color:TEXT_DARK, valign:"top", fontFace:"Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — SUMMARY TABLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  topBanner(s, "Summary");
  sTitle(s, "Platelet Apheresis: Quick Reference Summary");

  const hdr = ["Category", "Key Points", "Clinical Pearl"];
  const rows = [
    ["Product Specs", "≥3.0×10¹¹ platelets; ~100 mL; 5-day shelf life; 20–24°C + agitation", "~6× the platelets of one whole-blood unit"],
    ["Donor Criteria", "Plt ≥150K; no aspirin ×2d; no clopidogrel ×14d; max 24×/year", "FDA + AABB standards govern collection"],
    ["Transfusion Indications", "Prophylactic: <10K; surgical: 50–100K; active bleed: <50K (extracranial)", "CCI <5000 twice = refractory"],
    ["Refractoriness", "HLA alloimmunisation (immune) vs fever/sepsis/splenomegaly (non-immune)", "Use HLA-matched or crossmatched apheresis units"],
    ["Advantages over Pooled", "1 donor exposure; lower alloimmunisation; fewer infections; inventory mgmt", "TRAP Study: prestorage LR delays HLA immunisation"],
    ["Therapeutic Thrombocytapheresis", "Symptomatic ET/PV/CML (ASFA Cat II); temporary bridge for cytoreduction", "Effects last hours to days only"],
    ["Complications (Donor)", "Citrate toxicity (Ca²⁺ chelation); vasovagal; thrombocytopenia", "Replace calcium; monitor serial platelet counts"],
    ["Complications (Recipient)", "Sepsis; FNHTR; TA-GVHD; allergic; refractoriness; TRALI", "Irradiate for immunocompromised; PAS reduces allergy"],
  ];

  const cW = [2.6, 4.0, 3.0];
  const cX = [0.25, 2.85, 6.85];
  const tY = 1.52;

  hdr.forEach((h, ci) => {
    s.addShape(pres.ShapeType.rect, { x:cX[ci], y:tY, w:cW[ci], h:0.42, fill:{color: ci===0 ? DARK_BG : (ci===1 ? ACCENT1 : ACCENT2)} });
    s.addText(h, { x:cX[ci]+0.08, y:tY, w:cW[ci]-0.1, h:0.42, fontSize:10.5, bold:true, color:WHITE, valign:"middle", align:"center" });
  });
  rows.forEach((row, ri) => {
    const yR = tY + 0.42 + ri*0.49;
    const bg = ri%2===0 ? WHITE : CARD_BG;
    const lc = [ACCENT1,ACCENT2,ACCENT3,ACCENT4,MID_BG,ACCENT1,ACCENT2,ACCENT3][ri];
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x:cX[ci], y:yR, w:cW[ci], h:0.49, fill:{color: ci===0 ? "E8EEF4" : bg}, line:{color:"D0D8E0",width:0.5} });
      if (ci===0) s.addShape(pres.ShapeType.rect, { x:cX[ci], y:yR, w:0.16, h:0.49, fill:{color:lc} });
      s.addText(cell, { x:cX[ci]+(ci===0?0.22:0.1), y:yR, w:cW[ci]-(ci===0?0.27:0.15), h:0.49, fontSize:9.5, color:TEXT_DARK, valign:"middle", fontFace:"Calibri", bold:ci===0 });
    });
  });

  refBar(s, "Quick Compendium 5th ed. · Henry's · Goldman-Cecil · Tietz 7th ed. · Harriet Lane 23rd ed. · ASFA Guidelines 2019");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — REFERENCES
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.52, fill:{color:ACCENT1} });
  s.addText("REFERENCES", { x:0.3, y:0.03, w:9.4, h:0.47, fontSize:10, bold:true, color:WHITE, charSpacing:3, valign:"middle", margin:0 });

  s.addText("Textbooks", { x:0.4, y:0.62, w:9.0, h:0.36, fontSize:13, bold:true, color:ACCENT2 });
  const tbooks = [
    "Quick Compendium of Clinical Pathology, 5th ed. — Sections 2.6.2 (Platelets), 2.6.7.2 (Leukoreduction)",
    "Henry's Clinical Diagnosis and Management by Laboratory Methods — Platelet Apheresis, Thrombocytapheresis, Benefits of Apheresis Platelets",
    "Goldman-Cecil Medicine International Edition — Platelet Components, Pathogen Reduction",
    "Tietz Textbook of Laboratory Medicine, 7th ed. — Platelets (Transfusion), Leukoreduction",
    "Harriet Lane Handbook, 23rd ed. (Johns Hopkins) — Neonatal Platelet Transfusion",
    "Tintinalli's Emergency Medicine — Platelet Transfusion Indications",
    "Washington Manual of Medical Therapeutics — Platelet Dosing",
    "Barash Clinical Anesthesia, 9th ed. — Alloimmunisation and Apheresis Platelets",
  ];
  tbooks.forEach((t, i) => {
    s.addText("• "+t, { x:0.45, y:1.04+i*0.36, w:9.1, h:0.34, fontSize:10, color:TEXT_LITE, valign:"middle", fontFace:"Calibri" });
  });

  s.addText("Journal Articles", { x:0.4, y:3.98, w:9.0, h:0.34, fontSize:13, bold:true, color:ACCENT2 });
  const jarticles = [
    "Frontier L et al. Lower US plateletpheresis yield. Transfus Apher Sci. 2026. PMID: 41650546",
    "Tong N et al. Universal leukoreduction. Transfus Apher Sci. 2026. PMID: 41435793",
    "Ashok C et al. Plateletpheresis on Hb/Hct meta-analysis. Cureus. 2024. PMID: 38962593",
    "Raza S et al. Plasma exchange in platelet refractoriness. Transfus Apher Sci. 2023. PMID: 37550092",
    "Chapman JM et al. Platelet antibody testing in refractoriness. Transfus Apher Sci. 2023. PMID: 36535829",
    "Padmanabhan A et al. ASFA Guidelines. J Clin Apheresis. 2019.",
    "TRAP Study Group. Leukoreduction and HLA alloimmunisation. NEJM. 1997.",
  ];
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    s.addText("• "+j, { x:0.45, y:4.38+i*0.3, w:9.1, h:0.28, fontSize:9.5, color:ACCENT2, valign:"middle", fontFace:"Calibri" });
  });
}

// ─── WRITE ────────────────────────────────────────────────────────────────────
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  .then(() => console.log("SUCCESS"))
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