mkdir -p /home/daytona/workspace/blood-transfusion-pptx && ls /home/daytona/work…

~/blood-transfusion-pptx/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Blood Transfusion";
pres.author = "Medical Education";

// ─── THEME COLORS ───────────────────────────────────────────────
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// ─── HELPER: section-divider slide ──────────────────────────────
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// ─── HELPER: table slide ─────────────────────────────────────────
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// ════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ════════════════════════════════════════════════════════════════
{
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  // Title
  s.addText("Blood Transfusion", { x: 0.5, y: 0.6, w: 7.2, h: 1.3, fontSize: 44, bold: true, color: C.white, fontFace: "Calibri" });
  s.addText("A Comprehensive Clinical Overview", { x: 0.5, y: 2.0, w: 7.2, h: 0.6, fontSize: 22, color: C.gold, fontFace: "Calibri", italic: true });
  // Topics strip
  const topics = [
    "01 Definition", "02 Indications", "03 Patient Assessment",
    "04 Compatibility Testing", "05 Risks", "06 Benefits"
  ];
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  s.addText("References: Bailey & Love's Surgery 28e · Roberts & Hedges' Clinical Procedures · Henry's Clinical Diagnosis · Tietz Textbook of Laboratory Medicine · Rosen's Emergency Medicine", {
    x: 0.5, y: 4.0, w: 9, h: 0.7, fontSize: 10, color: "718096", fontFace: "Calibri", italic: true
  });
}

// ════════════════════════════════════════════════════════════════
// SECTION 1 — DEFINITION
// ════════════════════════════════════════════════════════════════
addDivider(pres, 1, "Definition of Blood Transfusion", "What it is, historical context & types of blood products");

addContent(pres, "Definition of Blood Transfusion", [
  { text: "Core Definition", bold: true },
  { text: "The intravenous transfer of whole blood or blood components from a donor to a recipient for therapeutic purposes.", sub: true },
  { text: '"Any blood transfusion is a serious undertaking. If regarded as a form of transplantation of regenerative tissue from a donor being given to a recipient, its importance is clearly understood."', sub: true },
  { text: "— Pye's Surgical Handicraft, 22nd Edition", sub: true },
  { text: " " },
  { text: "Key Concept", bold: true },
  { text: "Blood transfusion is essentially a form of tissue transplant and carries all the associated immunological risks.", sub: true },
  { text: "The procedure must be treated with the same degree of clinical gravity as organ transplantation.", sub: true },
], "Source: Pye's Surgical Handicraft, 22nd Ed.");

addContent(pres, "Types of Blood Products Transfused", [
  { text: "Whole Blood", bold: true },
  { text: "Contains all components: RBCs, plasma, platelets, and clotting factors. Used in massive haemorrhage and military settings.", sub: true },
  { text: "Packed Red Blood Cells (PRBCs)", bold: true },
  { text: "Most common product. Used for anaemia and acute blood loss. Provides oxygen-carrying capacity without volume overload.", sub: true },
  { text: "Fresh Frozen Plasma (FFP)", bold: true },
  { text: "Contains all clotting factors. Used in coagulopathy, liver disease, massive transfusion protocols.", sub: true },
  { text: "Platelet Concentrate", bold: true },
  { text: "Used for thrombocytopenia (<50,000/µL in active bleeding). Maintain platelet count >50,000/µL during active GI bleeding.", sub: true },
  { text: "Autologous Blood Transfusion", bold: true },
  { text: "Patient pre-donates their own blood before elective surgery, or intraoperative cell salvage (cell saver) is used.", sub: true },
], "Source: Bailey & Love's Surgery 28e; Rosen's Emergency Medicine");

// ════════════════════════════════════════════════════════════════
// SECTION 2 — INDICATIONS
// ════════════════════════════════════════════════════════════════
addDivider(pres, 2, "Indications for Blood Transfusion", "Clinical triggers and haemoglobin-based transfusion criteria");

addContent(pres, "Indications for Blood Transfusion", [
  { text: '"Blood transfusions should be avoided if possible, and many previous uses are now no longer considered appropriate."', sub: true },
  { text: "— Bailey & Love's Short Practice of Surgery, 28th Edition", sub: true },
  { text: " " },
  { text: "Accepted Clinical Indications", bold: true },
  { text: "Acute blood loss — to replace circulating volume and maintain oxygen delivery", sub: true },
  { text: "Perioperative anaemia — to ensure adequate oxygen delivery during the perioperative phase", sub: true },
  { text: "Symptomatic chronic anaemia — without haemorrhage or impending surgery", sub: true },
  { text: "Haematological disorders — sickle cell disease, thalassaemia, aplastic anaemia", sub: true },
  { text: "Massive haemorrhage protocols — trauma, obstetric haemorrhage, GI bleed", sub: true },
  { text: "Coagulopathy — FFP/platelets in DIC, liver failure, warfarin reversal", sub: true },
], "Source: Bailey & Love's Surgery 28e, p.42–43; Rosen's Emergency Medicine");

// Hb Trigger Table
{
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  s.addText("Transfusion Trigger — Haemoglobin Thresholds", { x: 0.3, y: 0.1, w: 9.4, h: 0.65, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });

  const rows = [
    [
      { text: "Hb Level (g/dL)", options: { bold: true, color: C.white, fill: C.darkBg, fontSize: 15 } },
      { text: "Transfusion Guidance", options: { bold: true, color: C.white, fill: C.darkBg, fontSize: 15 } }
    ],
    [
      { text: "< 6 g/dL", options: { bold: true, color: C.accent, fontSize: 14 } },
      { text: "Probably WILL benefit from transfusion", options: { fontSize: 14 } }
    ],
    [
      { text: "6 – 8 g/dL", options: { bold: true, color: C.midBg, fontSize: 14 } },
      { text: "Transfusion UNLIKELY to benefit in absence of bleeding or impending surgery", options: { fontSize: 14 } }
    ],
    [
      { text: "> 8 g/dL", options: { bold: true, color: "2F855A", fontSize: 14 } },
      { text: "NO indication for transfusion in absence of other risk factors", options: { fontSize: 14 } }
    ],
    [
      { text: "> 9 g/dL (CAD)", options: { bold: true, color: "744210", fontSize: 14 } },
      { text: "Target for patients with known/symptomatic coronary artery disease or cardiac ischaemia", options: { fontSize: 14 } }
    ],
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  s.addText("Historically Hb >10 g/dL was targeted — this is now shown to increase morbidity and mortality compared to restrictive strategies.", {
    x: 0.4, y: 4.7, w: 9.2, h: 0.55, fontSize: 13, color: C.subText, italic: true, fontFace: "Calibri"
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  s.addText("Source: Bailey & Love's Surgery 28e Table 2.6; Rosen's Emergency Medicine", { x: 0.3, y: 5.3, w: 9.4, h: 0.28, fontSize: 10, color: C.white, italic: true, fontFace: "Calibri" });
}

// ════════════════════════════════════════════════════════════════
// SECTION 3 — PATIENT ASSESSMENT
// ════════════════════════════════════════════════════════════════
addDivider(pres, 3, "Assessing Patients for Blood Transfusion", "Pre-transfusion evaluation, clinical & laboratory workup");

addContent(pres, "Clinical Assessment Before Transfusion", [
  { text: "History", bold: true },
  { text: "Previous transfusions and any transfusion reactions", sub: true },
  { text: "Known blood group / red cell alloantibodies", sub: true },
  { text: "Pregnancy history (Rh sensitisation risk)", sub: true },
  { text: "Medications (anticoagulants, immunosuppressants)", sub: true },
  { text: "Symptoms of anaemia: fatigue, dyspnoea, angina, syncope", sub: true },
  { text: "Examination", bold: true },
  { text: "Vital signs: HR, BP, temperature, respiratory rate, SpO₂", sub: true },
  { text: "Pallor, jaundice, oedema, signs of cardiac decompensation", sub: true },
  { text: "Active bleeding sites, estimated blood loss", sub: true },
], "Source: Henry's Clinical Diagnosis & Management by Laboratory Methods; Bailey & Love's 28e");

addContent(pres, "Laboratory Investigation for Transfusion Need", [
  { text: "Essential Pre-transfusion Laboratory Tests", bold: true },
  { text: "Full Blood Count (FBC) — Hb, Hct, platelet count, WBC", sub: true },
  { text: "ABO and Rh(D) blood grouping — mandatory before any transfusion", sub: true },
  { text: "Antibody screen — detect unexpected red cell alloantibodies", sub: true },
  { text: "Crossmatch — donor cells vs. recipient serum compatibility check", sub: true },
  { text: "Coagulation screen (PT, APTT, fibrinogen) — if FFP/platelets considered", sub: true },
  { text: "Special Populations Requiring Extra Care", bold: true },
  { text: "Neonates: weak/absent isohemagglutinins; maternally derived antibodies persist weeks after birth", sub: true },
  { text: "Multiply transfused patients: may develop multiple alloantibodies; provide antigen-matched RBCs", sub: true },
  { text: "Immunosuppressed patients: may lack expected ABO antibodies; use group O RBCs and AB plasma", sub: true },
], "Source: Henry's Clinical Diagnosis & Management by Laboratory Methods, Ch. 36");

addContent(pres, "Pretransfusion Testing — Step-by-Step Protocol", [
  { text: "Step 1: Patient identification", bold: true },
  { text: "Correctly labelled specimen with unique patient ID — most critical step to prevent fatal errors", sub: true },
  { text: "Step 2: ABO and Rh(D) typing", bold: true },
  { text: "At least TWO separate determinations of recipient ABO group required for electronic crossmatch", sub: true },
  { text: "Step 3: Antibody Screen", bold: true },
  { text: "Detects unexpected red cell antibodies. If positive → proceed to antibody identification", sub: true },
  { text: "Step 4: Crossmatch (Serological or Electronic)", bold: true },
  { text: "Final check of ABO compatibility. Full crossmatch takes ~45 minutes.", sub: true },
  { text: "Step 5: Specimen retention", bold: true },
  { text: "Pretransfusion samples must be retained for at least 7 days after each transfusion", sub: true },
], "Source: Henry's Clinical Diagnosis & Management by Laboratory Methods");

// ════════════════════════════════════════════════════════════════
// SECTION 4 — COMPATIBILITY TESTING
// ════════════════════════════════════════════════════════════════
addDivider(pres, 4, "Compatibility Testing", "ABO/Rh systems, crossmatching procedures and clinical significance");

addContent(pres, "The ABO Blood Group System", [
  { text: "Basis of the System", bold: true },
  { text: "Three allelic genes: A, B, and O — control synthesis of enzymes adding carbohydrate residues to RBC surface glycoproteins", sub: true },
  { text: "Naturally occurring antibodies are found in serum of those lacking the corresponding antigen", sub: true },
  { text: " " },
  { text: "Blood Group O: Universal Donor (no antigens → no reaction in recipient)", sub: true },
  { text: "Blood Group AB: Universal Recipient (no circulating antibodies → accepts any type)", sub: true },
  { text: " " },
  { text: "ABO Incompatibility Risk", bold: true },
  { text: "Severe, potentially fatal agglutination can occur with the FIRST transfusion of ABO-incompatible blood", sub: true },
  { text: "Most common cause: clerical errors — wrong patient identification at sample collection or blood administration", sub: true },
], "Source: Bailey & Love's Surgery 28e; Roberts & Hedges' Clinical Procedures in Emergency Medicine");

// ABO Table
{
  const s = pres.addSlide();
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  s.addText("ABO Blood Group System — Antigens, Antibodies & Frequency", { x: 0.3, y: 0.1, w: 9.4, h: 0.65, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
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      { text: "Phenotype", options: { bold: true, color: C.white, fill: C.darkBg } },
      { text: "Genotype", options: { bold: true, color: C.white, fill: C.darkBg } },
      { text: "Antigens on RBC", options: { bold: true, color: C.white, fill: C.darkBg } },
      { text: "Antibodies in Serum", options: { bold: true, color: C.white, fill: C.darkBg } },
      { text: "Frequency (UK)", options: { bold: true, color: C.white, fill: C.darkBg } },
    ],
    [
      { text: "O", options: { bold: true, fontSize: 15 } },
      { text: "OO", options: { fontSize: 14 } },
      { text: "O", options: { fontSize: 14 } },
      { text: "Anti-A, Anti-B", options: { fontSize: 14, bold: true, color: C.accent } },
      { text: "46%  (Universal Donor)", options: { fontSize: 14, bold: true, color: "2F855A" } },
    ],
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      { text: "A", options: { bold: true, fontSize: 15 } },
      { text: "AA or AO", options: { fontSize: 14 } },
      { text: "A", options: { fontSize: 14 } },
      { text: "Anti-B", options: { fontSize: 14, color: C.accent } },
      { text: "42%", options: { fontSize: 14 } },
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    [
      { text: "B", options: { bold: true, fontSize: 15 } },
      { text: "BB or BO", options: { fontSize: 14 } },
      { text: "B", options: { fontSize: 14 } },
      { text: "Anti-A", options: { fontSize: 14, color: C.accent } },
      { text: "9%", options: { fontSize: 14 } },
    ],
    [
      { text: "AB", options: { bold: true, fontSize: 15 } },
      { text: "AB", options: { fontSize: 14 } },
      { text: "A and B", options: { fontSize: 14 } },
      { text: "None", options: { fontSize: 14, bold: true, color: "2F855A" } },
      { text: "3%  (Universal Recipient)", options: { fontSize: 14, bold: true, color: "2F855A" } },
    ],
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  s.addTable(rows, { x: 0.3, y: 0.95, w: 9.4, colW: [1.4, 1.5, 1.9, 2.4, 2.2], fontFace: "Calibri", border: { pt: 1, color: "CCCCCC" }, rowH: 0.7 });
  s.addText("Source: Bailey & Love's Short Practice of Surgery, 28th Edition, Table 2.7", { x: 0.3, y: 5.3, w: 9.4, h: 0.28, fontSize: 10, color: C.white, italic: true, fontFace: "Calibri" });
}

addContent(pres, "The Rhesus (Rh) Blood Group System", [
  { text: "Rh(D) Antigen", bold: true },
  { text: "Strongly antigenic; present in ~85% of the UK population (Rh-positive)", sub: true },
  { text: "Antibodies are NOT naturally present — formed only after exposure to Rh+ blood", sub: true },
  { text: " " },
  { text: "Clinical Significance", bold: true },
  { text: "Transfusing Rh+ blood to Rh− patient → forms anti-D antibodies", sub: true },
  { text: "Second exposure to Rh antigen → severe haemolytic reaction", sub: true },
  { text: "In pregnancy: maternal anti-D crosses placenta → Haemolytic Disease of the Newborn (HDN) / Hydrops Fetalis", sub: true },
  { text: " " },
  { text: "Other Important Antigen Systems", bold: true },
  { text: "Kell (K/k), Duffy (Fyᵃ/Fyᵇ), Kidd (Jkᵃ/Jkᵇ), MNS systems — clinically relevant in patients requiring repeated transfusions (e.g., sickle cell disease)", sub: true },
], "Source: Bailey & Love's Surgery 28e; Roberts & Hedges' Clinical Procedures in Emergency Medicine");

addContent(pres, "Crossmatching — Procedure and Types", [
  { text: '"Compatibility testing involves mixing the donor\'s RBCs and serum with the serum and RBCs of the recipient to identify the potential for a transfusion reaction."', sub: true },
  { text: "— Roberts & Hedges' Clinical Procedures in Emergency Medicine", sub: true },
  { text: " " },
  { text: "Types of Crossmatch", bold: true },
  { text: "Serological (Full) Crossmatch — ~45 minutes. Mixes donor RBCs with recipient serum. Incubated at 37°C with antiglobulin reagent. Detects ABO + other antibodies.", sub: true },
  { text: "Type-Specific Blood — ABO/Rh matched only; issued within 10–15 minutes in urgent situations", sub: true },
  { text: "Electronic (Computer) Crossmatch — Valid when ≥2 prior ABO determinations exist and antibody screen is negative", sub: true },
  { text: "Emergency Release (Group O) — O− for females of childbearing age; O+ for males. No crossmatch required.", sub: true },
  { text: " " },
  { text: "End-point: Presence of RBC agglutination (gross or microscopic) or haemolysis = INCOMPATIBLE", sub: true },
], "Source: Roberts & Hedges' Clinical Procedures; Henry's Clinical Diagnosis & Management by Laboratory Methods");

// ════════════════════════════════════════════════════════════════
// SECTION 5 — RISKS
// ════════════════════════════════════════════════════════════════
addDivider(pres, 5, "Risks of Blood Transfusion", "Acute and delayed reactions, infectious risks and preventive strategies");

addContent(pres, "Classification of Transfusion Reactions", [
  { text: "Transfusion reactions are classified as ACUTE (during or within hours) or DELAYED (>24 hours after transfusion)", sub: true },
  { text: "In 2017, 44 fatal transfusion reactions were reported in the United States (NHSN Hemovigilance Module)", sub: true },
  { text: "Allergic reactions account for ~46.8% of all adverse transfusion reactions", sub: true },
  { text: " " },
  { text: "ACUTE REACTIONS", bold: true },
  { text: "Acute Haemolytic Transfusion Reaction (AHTR) — ABO incompatibility → IgM activation → complement-mediated intravascular haemolysis → MOF", sub: true },
  { text: "Febrile Non-Haemolytic Reaction (FNHTR) — Graft-vs-host leukocyte response; fever, chills/rigors. Rare with leukodepleted blood.", sub: true },
  { text: "Allergic / Anaphylactic Reaction — 1–4% of transfusions. Anaphylaxis <0.1%. Urticaria, bronchospasm, shock.", sub: true },
  { text: "TRALI (Transfusion-Related Acute Lung Injury) — Antibodies in donor plasma activate recipient neutrophils → non-cardiogenic pulmonary oedema", sub: true },
  { text: "TACO (Transfusion-Associated Circulatory Overload) — Volume overload → pulmonary oedema (risk in elderly, cardiac disease)", sub: true },
], "Source: Tietz Textbook of Laboratory Medicine, 7th Ed., Ch. 93; Bailey & Love's Surgery 28e");

addContent(pres, "Delayed and Infectious Risks", [
  { text: "DELAYED REACTIONS", bold: true },
  { text: "Delayed Haemolytic Transfusion Reaction (DHTR) — Anamnestic antibody response to minor antigens, 3–10 days post-transfusion; Coombs-positive haemolysis", sub: true },
  { text: "Transfusion-Associated Graft vs Host Disease (TA-GvHD) — Donor T-lymphocytes attack immunocompromised host tissues; often fatal → prevented by irradiation of blood products", sub: true },
  { text: "Post-Transfusion Purpura (PTP) — Sudden severe thrombocytopenia 5–12 days post-transfusion; anti-HPA-1a antibodies", sub: true },
  { text: "Iron Overload — In chronically transfused patients (thalassaemia, myelodysplasia); requires chelation therapy", sub: true },
  { text: " " },
  { text: "INFECTIOUS RISKS", bold: true },
  { text: "HIV: ~1:1.5 million per unit (modern screened blood)", sub: true },
  { text: "Hepatitis B/C: extremely low with nucleic acid testing (NAT)", sub: true },
  { text: "Bacterial contamination: higher risk with platelets (stored at room temperature)", sub: true },
], "Source: Tietz Textbook of Laboratory Medicine 7e; Bailey & Love's Surgery 28e");

addTwoCol(pres,
  "Prevention of Transfusion Reactions",
  "Pre-Transfusion Safeguards",
  [
    "Correct patient identification at sample collection AND bedside",
    "Two-person verification: patient details vs blood label",
    "Full ABO/Rh typing + antibody screen before every transfusion",
    "Full crossmatch (45 min) when time allows",
    "Leukodepletion of blood products — prevents FNHTR and TA-GvHD",
    "Irradiation for immunocompromised patients — prevents TA-GvHD",
  ],
  "Management if Reaction Occurs",
  [
    "STOP the transfusion immediately",
    "Keep IV line open with normal saline",
    "Check patient identity and blood product labels",
    "Notify the blood bank — return blood bag for testing",
    "Supportive treatment: IV fluids, antihistamines, adrenaline for anaphylaxis",
    "Haemovigilance reporting to NHSN/SHOT",
  ],
  "Source: Bailey & Love's Surgery 28e; Tietz Textbook of Laboratory Medicine 7e"
);

// ════════════════════════════════════════════════════════════════
// SECTION 6 — BENEFITS
// ════════════════════════════════════════════════════════════════
addDivider(pres, 6, "Benefits of Blood Transfusion", "Life-saving clinical value and patient blood management");

addContent(pres, "Benefits of Blood Transfusion", [
  { text: "1. Restoration of Oxygen-Carrying Capacity", bold: true },
  { text: "PRBCs provide haemoglobin → restores tissue oxygen delivery in haemorrhage and severe anaemia", sub: true },
  { text: "Critical in trauma, surgical blood loss, and perioperative care", sub: true },
  { text: "2. Reversal of Haemodynamic Instability", bold: true },
  { text: "Rapid restoration of circulating volume in exsanguinating haemorrhage → prevents shock, organ failure and death", sub: true },
  { text: "3. Correction of Coagulopathy", bold: true },
  { text: "FFP restores clotting factors in DIC, liver failure, and massive haemorrhage protocols", sub: true },
  { text: "Platelet transfusion prevents/treats life-threatening bleeding in thrombocytopenia", sub: true },
  { text: "4. Management of Haematological Conditions", bold: true },
  { text: "Exchange transfusion in sickle cell crisis reduces HbS% and prevents end-organ damage", sub: true },
  { text: "Regular transfusions in thalassaemia major prevent chronic hypoxia and cardiac failure", sub: true },
], "Source: Bailey & Love's Surgery 28e; Henry's Clinical Diagnosis & Management; Rosen's Emergency Medicine");

addContent(pres, "Patient Blood Management (PBM) — The Modern Approach", [
  { text: "Patient Blood Management (PBM) is an evidence-based, patient-centred strategy to optimise patient outcomes by managing and preserving a patient's own blood.", sub: true },
  { text: " " },
  { text: "Three Pillars of PBM", bold: true },
  { text: "Pillar 1 — Optimise red cell mass BEFORE surgery: treat preoperative anaemia with iron, EPO, B12/folate", sub: true },
  { text: "Pillar 2 — Minimise blood loss DURING procedure: surgical haemostasis, cell salvage, antifibrinolytics (tranexamic acid)", sub: true },
  { text: "Pillar 3 — Optimise tolerance of anaemia AFTER: restrictive transfusion thresholds, volume optimisation, high-flow O₂", sub: true },
  { text: " " },
  { text: "A restrictive transfusion strategy (Hb threshold 7–8 g/dL) is associated with lower all-cause mortality and rebleeding vs liberal strategy.", sub: true },
], "Source: Henry's Clinical Diagnosis & Management; Bailey & Love's Surgery 28e; Rosen's Emergency Medicine");

// ════════════════════════════════════════════════════════════════
// FINAL SLIDE — SUMMARY
// ════════════════════════════════════════════════════════════════
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    "Blood transfusion = tissue transplant; treat with clinical gravity",
    "Indications: acute blood loss, perioperative & symptomatic chronic anaemia, coagulopathy",
    "Assess patients with FBC, blood grouping, antibody screen, and crossmatch before transfusion",
    "Compatibility testing (ABO/Rh typing + crossmatch) is mandatory to prevent fatal haemolytic reactions",
    "Risks: AHTR, FNHTR, TRALI, TACO, TA-GvHD, infections — prevention relies on strict patient ID checks",
    "Benefits: restores O₂ delivery, reverses shock, corrects coagulopathy, manages haematological disease",
    "Patient Blood Management: restrict transfusions, optimise alternatives, use restrictive Hb thresholds (7–8 g/dL)",
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  s.addText("References: Bailey & Love's Surgery 28e · Roberts & Hedges' Clinical Procedures · Henry's Clinical Diagnosis · Tietz Textbook of Laboratory Medicine · Rosen's Emergency Medicine · Pye's Surgical Handicraft 22e", {
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