Blood Transfusion and Blood Bank: A Clinical Reference for Doctors

#!/usr/bin/env python3
"""
Blood Transfusion Protocols & Reaction Flowcharts - Clinical Reference PDF
Generated with ReportLab
"""

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm, cm
from reportlab.lib import colors
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    PageBreak, HRFlowable, KeepTogether
)
from reportlab.platypus.flowables import Flowable
from reportlab.graphics.shapes import Drawing, Rect, String, Line, Polygon, Arrow
from reportlab.graphics import renderPDF
import os

OUTPUT_PATH = "/tmp/workspace/blood-transfusion-pdf/Blood_Transfusion_Protocols.pdf"

# ─── Color Palette ────────────────────────────────────────────────────────────
DEEP_RED     = colors.HexColor("#8B0000")
MED_RED      = colors.HexColor("#C0392B")
LIGHT_RED    = colors.HexColor("#FADBD8")
DARK_BLUE    = colors.HexColor("#1A3C5E")
MED_BLUE     = colors.HexColor("#2E86C1")
LIGHT_BLUE   = colors.HexColor("#D6EAF8")
TEAL         = colors.HexColor("#117A65")
LIGHT_TEAL   = colors.HexColor("#D1F2EB")
ORANGE       = colors.HexColor("#D35400")
LIGHT_ORANGE = colors.HexColor("#FAE5D3")
YELLOW_BG    = colors.HexColor("#FEF9E7")
DARK_GREY    = colors.HexColor("#2C3E50")
MID_GREY     = colors.HexColor("#7F8C8D")
LIGHT_GREY   = colors.HexColor("#ECF0F1")
WHITE        = colors.white
BLACK        = colors.black
GOLD         = colors.HexColor("#F39C12")

W, H = A4  # 595.27 x 841.89 pts

# ─── Styles ───────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def make_style(name, parent='Normal', **kwargs):
    return ParagraphStyle(name, parent=styles[parent], **kwargs)

TITLE_STYLE = make_style('DocTitle', fontSize=24, textColor=WHITE,
                          fontName='Helvetica-Bold', alignment=TA_CENTER, leading=30)
SUBTITLE_STYLE = make_style('DocSubtitle', fontSize=11, textColor=colors.HexColor("#BDC3C7"),
                             fontName='Helvetica', alignment=TA_CENTER, leading=16)
SECTION_STYLE = make_style('SectionHead', fontSize=13, textColor=WHITE,
                            fontName='Helvetica-Bold', alignment=TA_LEFT, leading=18)
BODY_STYLE = make_style('Body', fontSize=8.5, textColor=DARK_GREY,
                         fontName='Helvetica', leading=13, spaceAfter=4)
BODY_BOLD = make_style('BodyBold', fontSize=8.5, textColor=DARK_GREY,
                        fontName='Helvetica-Bold', leading=13)
SMALL_STYLE = make_style('Small', fontSize=7.5, textColor=MID_GREY,
                          fontName='Helvetica', leading=11)
TABLE_HDR = make_style('TblHdr', fontSize=8, textColor=WHITE,
                        fontName='Helvetica-Bold', alignment=TA_CENTER, leading=11)
TABLE_CELL = make_style('TblCell', fontSize=8, textColor=DARK_GREY,
                         fontName='Helvetica', leading=11)
TABLE_CELL_BOLD = make_style('TblCellBold', fontSize=8, textColor=DARK_GREY,
                               fontName='Helvetica-Bold', leading=11)
TABLE_CELL_CENTER = make_style('TblCellC', fontSize=8, textColor=DARK_GREY,
                                fontName='Helvetica', alignment=TA_CENTER, leading=11)
WARNING_STYLE = make_style('Warning', fontSize=8.5, textColor=MED_RED,
                            fontName='Helvetica-Bold', leading=13)
FLOW_TEXT = make_style('FlowText', fontSize=8, textColor=DARK_GREY,
                        fontName='Helvetica', alignment=TA_CENTER, leading=11)
FLOW_TEXT_BOLD = make_style('FlowTextBold', fontSize=8, textColor=WHITE,
                              fontName='Helvetica-Bold', alignment=TA_CENTER, leading=11)
CAPTION = make_style('Caption', fontSize=7.5, textColor=MID_GREY,
                      fontName='Helvetica-Oblique', alignment=TA_CENTER, leading=10)


# ─── Header/Footer ────────────────────────────────────────────────────────────
def on_page(canvas, doc):
    canvas.saveState()
    # Footer bar
    canvas.setFillColor(DARK_BLUE)
    canvas.rect(0, 0, W, 18*mm, fill=1, stroke=0)
    canvas.setFillColor(WHITE)
    canvas.setFont('Helvetica', 7.5)
    canvas.drawString(15*mm, 6*mm, "Blood Transfusion Protocols & Reference  |  Clinical Summary")
    canvas.drawRightString(W - 15*mm, 6*mm, f"Page {doc.page}")
    canvas.setFillColor(GOLD)
    canvas.rect(0, 17*mm, W, 1.5*mm, fill=1, stroke=0)
    canvas.restoreState()

def on_first_page(canvas, doc):
    on_page(canvas, doc)


# ─── Custom Flowables ─────────────────────────────────────────────────────────
class SectionHeader(Flowable):
    def __init__(self, text, color=DARK_BLUE, width=None):
        super().__init__()
        self.text = text
        self.color = color
        self.width = width or (W - 30*mm)
        self.height = 22*mm

    def draw(self):
        c = self.canv
        c.setFillColor(self.color)
        c.roundRect(0, 2*mm, self.width, 16*mm, 3*mm, fill=1, stroke=0)
        # Accent strip
        c.setFillColor(GOLD)
        c.rect(0, 2*mm, 4*mm, 16*mm, fill=1, stroke=0)
        c.setFillColor(WHITE)
        c.setFont('Helvetica-Bold', 12)
        c.drawString(8*mm, 8.5*mm, self.text)

    def wrap(self, avW, avH):
        return self.width, self.height


class BoxedNote(Flowable):
    def __init__(self, text, bg=LIGHT_RED, border=MED_RED, icon="!", width=None):
        super().__init__()
        self.text = text
        self.bg = bg
        self.border = border
        self.icon = icon
        self.width = width or (W - 30*mm)
        self.height = 18*mm

    def draw(self):
        c = self.canv
        c.setFillColor(self.bg)
        c.setStrokeColor(self.border)
        c.setLineWidth(1.5)
        c.roundRect(0, 0, self.width, 14*mm, 2*mm, fill=1, stroke=1)
        # Icon circle
        c.setFillColor(self.border)
        c.circle(7*mm, 7*mm, 4*mm, fill=1, stroke=0)
        c.setFillColor(WHITE)
        c.setFont('Helvetica-Bold', 9)
        c.drawCentredString(7*mm, 5*mm, self.icon)
        # Text
        c.setFillColor(DARK_GREY)
        c.setFont('Helvetica-Bold', 8)
        c.drawString(14*mm, 5.5*mm, self.text)

    def wrap(self, avW, avH):
        return self.width, self.height


class FlowchartBox(Flowable):
    """Renders a complete flowchart as a drawing"""
    def __init__(self, drawing, width, height):
        super().__init__()
        self._drawing = drawing
        self.width = width
        self.height = height

    def draw(self):
        renderPDF.draw(self._drawing, self.canv, 0, 0)

    def wrap(self, avW, avH):
        return self.width, self.height


# ─── Helper: draw flowchart box ───────────────────────────────────────────────
def fc_rect(d, x, y, w, h, text, fill=DARK_BLUE, text_color=WHITE, font_size=8, radius=4):
    d.add(Rect(x, y, w, h, rx=radius, ry=radius, fillColor=fill,
               strokeColor=colors.HexColor("#BDC3C7"), strokeWidth=0.8))
    lines = text.split('\n')
    total_h = len(lines) * (font_size + 2)
    start_y = y + h/2 + total_h/2 - font_size
    for i, line in enumerate(lines):
        d.add(String(x + w/2, start_y - i*(font_size+2), line,
                     fontName='Helvetica-Bold' if i == 0 else 'Helvetica',
                     fontSize=font_size, fillColor=text_color,
                     textAnchor='middle'))

def fc_diamond(d, cx, cy, w, h, text, fill=ORANGE, text_color=WHITE, font_size=7.5):
    points = [cx, cy+h/2, cx+w/2, cy, cx, cy-h/2, cx-w/2, cy]
    d.add(Polygon(points, fillColor=fill, strokeColor=colors.HexColor("#BDC3C7"), strokeWidth=0.8))
    lines = text.split('\n')
    for i, line in enumerate(lines):
        d.add(String(cx, cy + (len(lines)-1)*(font_size+1)/2 - i*(font_size+1),
                     line, fontName='Helvetica-Bold', fontSize=font_size,
                     fillColor=text_color, textAnchor='middle'))

def fc_arrow(d, x1, y1, x2, y2, color=DARK_GREY, label='', label_side='right'):
    d.add(Line(x1, y1, x2, y2, strokeColor=color, strokeWidth=1.2))
    # Arrowhead
    if y2 < y1:  # downward
        d.add(Polygon([x2, y2, x2-4, y2+7, x2+4, y2+7], fillColor=color, strokeWidth=0))
    elif y2 > y1:  # upward
        d.add(Polygon([x2, y2, x2-4, y2-7, x2+4, y2-7], fillColor=color, strokeWidth=0))
    elif x2 > x1:  # right
        d.add(Polygon([x2, y2, x2-7, y2+4, x2-7, y2-4], fillColor=color, strokeWidth=0))
    elif x2 < x1:  # left
        d.add(Polygon([x2, y2, x2+7, y2+4, x2+7, y2-4], fillColor=color, strokeWidth=0))
    if label:
        lx = (x1+x2)/2 + (5 if label_side=='right' else -5)
        ly = (y1+y2)/2
        d.add(String(lx, ly, label, fontName='Helvetica', fontSize=7,
                     fillColor=ORANGE, textAnchor='start' if label_side=='right' else 'end'))

def fc_label(d, x, y, text, color=TEAL, font_size=7):
    d.add(String(x, y, text, fontName='Helvetica-Bold', fontSize=font_size,
                 fillColor=color, textAnchor='middle'))


# ─── Build Flowchart: Transfusion Reaction Management ─────────────────────────
def build_reaction_flowchart():
    dw, dh = 480, 560
    d = Drawing(dw, dh)
    d.add(Rect(0, 0, dw, dh, fillColor=colors.HexColor("#F8FBFF"), strokeColor=LIGHT_GREY, strokeWidth=1))

    cx = dw / 2
    bw, bh = 200, 28
    # Start
    fc_rect(d, cx-bw/2, dh-50, bw, bh, "SUSPECT TRANSFUSION REACTION\n(fever, chills, pain, dyspnea, hemoglobinuria)",
            fill=MED_RED, font_size=7.5)
    fc_arrow(d, cx, dh-50, cx, dh-50-18)

    # Step 1
    y1 = dh - 110
    fc_rect(d, cx-bw/2, y1, bw, bh, "STEP 1: STOP TRANSFUSION IMMEDIATELY\nKeep IV line open with 0.9% NaCl",
            fill=DARK_BLUE, font_size=7.5)
    fc_arrow(d, cx, y1, cx, y1-18)

    # Step 2
    y2 = dh - 170
    fc_rect(d, cx-bw/2, y2, bw, bh, "STEP 2: CLERICAL CHECK\nVerify patient ID, unit label, compatibility tag",
            fill=DARK_BLUE, font_size=7.5)
    fc_arrow(d, cx, y2, cx, y2-18)

    # Step 3
    y3 = dh - 230
    fc_rect(d, cx-bw/2, y3, bw, bh, "STEP 3: NOTIFY BLOOD BANK & PHYSICIAN\nSend unit + tubing back to blood bank",
            fill=DARK_BLUE, font_size=7.5)
    fc_arrow(d, cx, y3, cx, y3-18)

    # Step 4 - Labs
    y4 = dh - 290
    fc_rect(d, cx-bw/2, y4, bw, bh, "STEP 4: SEND SAMPLES\nPost-Tx blood (EDTA+clot), urine sample",
            fill=TEAL, font_size=7.5)
    fc_arrow(d, cx, y4, cx, y4-25)

    # Diamond - hemolysis?
    y5 = dh - 348
    fc_diamond(d, cx, y5, 160, 38, "Evidence of\nHEMOLYSIS?", fill=ORANGE, font_size=8)
    
    # YES branch (left)
    fc_arrow(d, cx-80, y5, cx-80-50, y5, label='YES', label_side='left')
    fc_rect(d, cx-80-50-90, y5-14, 90, 55, "HEMOLYTIC RXN\n- Supportive care\n- Maintain UO\n- Treat DIC\n- Repeat ABO/DAT\n- Report to FDA",
            fill=MED_RED, font_size=7)

    # NO branch (right)
    fc_arrow(d, cx+80, y5, cx+80+50, y5, label='NO', label_side='right')
    fc_rect(d, cx+80+50, y5-14, 90, 40, "NON-HEMOLYTIC\n- Antipyretics\n- Antihistamine\n- May restart", fill=TEAL, font_size=7)

    # Bottom diamond - type of non-hemolytic
    fc_arrow(d, cx, y5-19, cx, y5-19-20)
    y6 = y5 - 75
    fc_diamond(d, cx, y6, 170, 38, "TRALI or TACO?", fill=DARK_BLUE, font_size=8)

    # TRALI
    fc_arrow(d, cx-85, y6, cx-85-40, y6, label='TRALI', label_side='left')
    fc_rect(d, cx-85-40-90, y6-14, 90, 40, "TRALI:\n- O2/ventilation\n- NO diuretics\n- Supportive",
            fill=MED_BLUE, font_size=7)

    # TACO
    fc_arrow(d, cx+85, y6, cx+85+40, y6, label='TACO', label_side='right')
    fc_rect(d, cx+85+40, y6-14, 90, 40, "TACO:\n- O2 + sit upright\n- Furosemide\n- Slow/stop Tx",
            fill=TEAL, font_size=7)

    # Bottom note
    d.add(Rect(10, 8, dw-20, 22, fillColor=LIGHT_RED, strokeColor=MED_RED, strokeWidth=0.8, rx=3, ry=3))
    d.add(String(dw/2, 15, "⚠  Fatalities must be reported to FDA by phone ASAP + written report within 7 days",
                  fontName='Helvetica-Bold', fontSize=7.5, fillColor=MED_RED, textAnchor='middle'))

    return FlowchartBox(d, dw, dh)


# ─── Build Flowchart: pRBC Transfusion Decision ───────────────────────────────
def build_prbc_flowchart():
    dw, dh = 480, 420
    d = Drawing(dw, dh)
    d.add(Rect(0, 0, dw, dh, fillColor=colors.HexColor("#F8FBFF"), strokeColor=LIGHT_GREY, strokeWidth=1))

    cx = dw / 2
    bw, bh = 200, 28

    # Start
    fc_rect(d, cx-bw/2, dh-50, bw, bh, "PATIENT REQUIRES BLOOD TRANSFUSION\nCheck Hb, clinical status, consent",
            fill=DARK_BLUE, font_size=7.5)
    fc_arrow(d, cx, dh-50, cx, dh-50-18)

    # Emergency?
    y1 = dh - 115
    fc_diamond(d, cx, y1, 180, 40, "LIFE-THREATENING\nHEMORRHAGE?", fill=MED_RED, font_size=8)
    
    # YES - emergency
    fc_arrow(d, cx+90, y1, cx+90+40, y1, label='YES', label_side='right')
    fc_rect(d, cx+90+40, y1-14, 95, 40, "EMERGENCY:\nGroup O pRBCs\n+ Group AB plasma\n(pre-crossmatch)",
            fill=MED_RED, font_size=7)

    # NO - stable
    fc_arrow(d, cx, y1-20, cx, y1-20-18, label='NO')
    y2 = dh - 198
    fc_rect(d, cx-bw/2, y2, bw, bh, "TYPE & SCREEN / CROSSMATCH\nCheck ABO/Rh, antibody screen",
            fill=TEAL, font_size=7.5)
    fc_arrow(d, cx, y2, cx, y2-18)

    # Hb threshold decision
    y3 = dh - 265
    fc_diamond(d, cx, y3, 190, 50, "Hb THRESHOLD\n(see table)", fill=ORANGE, font_size=8)

    # Branches
    x_left = cx - 140
    x_right = cx + 140

    # Hb < 7 (general)
    fc_arrow(d, x_left, y3+10, x_left, y3+10-15)
    fc_rect(d, x_left-70, y3+10-15-35, 140, 40,
            "Hb < 7 g/dL\nStable patient\n→ Transfuse 1 unit\nRecheck Hb",
            fill=DARK_BLUE, font_size=7)

    # Hb < 8 (post-op/CAD)
    fc_arrow(d, cx, y3-25, cx, y3-25-15)
    fc_rect(d, cx-70, y3-25-15-35, 140, 40,
            "Hb < 8 g/dL\nCAD / surgical\n→ Transfuse 1 unit\nRecheck Hb",
            fill=MED_BLUE, font_size=7)

    # Symptoms
    fc_arrow(d, x_right, y3+10, x_right, y3+10-15)
    fc_rect(d, x_right-70, y3+10-15-35, 140, 40,
            "Symptomatic anemia\n(any Hb level)\n→ Transfuse\nbased on symptoms",
            fill=TEAL, font_size=7)

    # Bottom note
    d.add(Rect(10, 8, dw-20, 22, fillColor=LIGHT_BLUE, strokeColor=MED_BLUE, strokeWidth=0.8, rx=3, ry=3))
    d.add(String(dw/2, 15,
                  "One unit at a time strategy: transfuse 1 unit, reassess Hb and symptoms before next unit",
                  fontName='Helvetica-Bold', fontSize=7.5, fillColor=DARK_BLUE, textAnchor='middle'))

    return FlowchartBox(d, dw, dh)


# ─── Build Flowchart: Massive Transfusion Protocol ───────────────────────────
def build_mtp_flowchart():
    dw, dh = 480, 340
    d = Drawing(dw, dh)
    d.add(Rect(0, 0, dw, dh, fillColor=colors.HexColor("#FFF8F8"), strokeColor=LIGHT_GREY, strokeWidth=1))

    cx = dw / 2

    # Title bar
    d.add(Rect(10, dh-38, dw-20, 28, fillColor=MED_RED, rx=4, ry=4, strokeWidth=0))
    d.add(String(cx, dh-28, "MASSIVE TRANSFUSION PROTOCOL (MTP)",
                  fontName='Helvetica-Bold', fontSize=10, fillColor=WHITE, textAnchor='middle'))

    # Trigger box
    d.add(Rect(cx-100, dh-85, 200, 32, fillColor=LIGHT_RED, strokeColor=MED_RED, strokeWidth=1, rx=3))
    d.add(String(cx, dh-63, "TRIGGER: ≥10 pRBC/24h OR 1 blood volume/24h",
                  fontName='Helvetica-Bold', fontSize=7.5, fillColor=MED_RED, textAnchor='middle'))
    d.add(String(cx, dh-74, "Massive hemorrhage (trauma, OB, surgical)",
                  fontName='Helvetica', fontSize=7.5, fillColor=DARK_GREY, textAnchor='middle'))

    fc_arrow(d, cx, dh-85, cx, dh-85-12)

    # MTP Pack
    pack_y = dh - 165
    d.add(Rect(cx-160, pack_y, 320, 52, fillColor=DARK_BLUE, rx=4, ry=4, strokeWidth=0))
    d.add(String(cx, pack_y+40, "MTP PACK  (1:1:1 RATIO)",
                  fontName='Helvetica-Bold', fontSize=9, fillColor=GOLD, textAnchor='middle'))
    d.add(String(cx, pack_y+26, "6 units pRBC  +  6 units FFP  +  1 apheresis platelet",
                  fontName='Helvetica-Bold', fontSize=8.5, fillColor=WHITE, textAnchor='middle'))
    d.add(String(cx, pack_y+14, "Consider: Cryoprecipitate (if fibrinogen <150 mg/dL)  |  TXA (tranexamic acid)",
                  fontName='Helvetica', fontSize=7.5, fillColor=colors.HexColor("#AED6F1"), textAnchor='middle'))

    fc_arrow(d, cx, pack_y, cx, pack_y-14)

    # Complications row
    comp_y = pack_y - 75
    comps = [
        ("HYPOTHERMIA", "Use blood warmers", DARK_BLUE),
        ("HYPOCALCEMIA", "Monitor & replace\nionized Ca²⁺", TEAL),
        ("COAGULOPATHY", "Balance ratios\nAvoid pRBC-only", MED_RED),
        ("HYPERKALEMIA", "Monitor in renal\nfailure/neonates", ORANGE),
    ]
    n = len(comps)
    box_w = (dw - 40) / n
    for i, (title, note, col) in enumerate(comps):
        bx = 20 + i * box_w
        d.add(Rect(bx, comp_y, box_w-6, 50, fillColor=col, rx=3, ry=3, strokeWidth=0))
        d.add(String(bx+box_w/2-3, comp_y+37, title, fontName='Helvetica-Bold',
                      fontSize=7, fillColor=WHITE, textAnchor='middle'))
        for j, line in enumerate(note.split('\n')):
            d.add(String(bx+box_w/2-3, comp_y+24-j*10, line, fontName='Helvetica',
                          fontSize=7, fillColor=colors.HexColor("#D5D8DC"), textAnchor='middle'))

    # Bottom
    d.add(Rect(10, 8, dw-20, 20, fillColor=YELLOW_BG, strokeColor=GOLD, strokeWidth=0.8, rx=3))
    d.add(String(cx, 14, "Reassess after each pack  |  Communicate clearly with blood bank  |  Activate/deactivate MTP explicitly",
                  fontName='Helvetica-Bold', fontSize=7.5, fillColor=DARK_GREY, textAnchor='middle'))

    return FlowchartBox(d, dw, dh)


# ─── Build Summary Compatibility Table ───────────────────────────────────────
def build_abo_table():
    header = [Paragraph(t, TABLE_HDR) for t in
              ["Blood Group", "ABO Antibodies", "RBC Donors", "Plasma Donors", "Rh Note"]]
    rows = [
        ["O", "Anti-A, Anti-B", "O only\n(Universal RBC donor)", "O, A, B, AB", "O neg = universal\npRBC donor"],
        ["A", "Anti-B", "A, O", "A, AB", ""],
        ["B", "Anti-A", "B, O", "B, AB", ""],
        ["AB", "None", "A, B, O, AB\n(Universal recipient)", "AB only\n(Universal plasma)", "AB = universal\nplasma donor"],
    ]
    bgs = [LIGHT_BLUE, LIGHT_GREY, LIGHT_BLUE, LIGHT_GREY]
    data = [header]
    for i, row in enumerate(rows):
        data.append([Paragraph(str(c), TABLE_CELL_BOLD if i == 0 or i == 3 else TABLE_CELL) for c in row])

    tbl = Table(data, colWidths=[28*mm, 35*mm, 45*mm, 38*mm, 38*mm])
    tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), DARK_BLUE),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [LIGHT_BLUE, LIGHT_GREY, LIGHT_BLUE, colors.HexColor("#E8F8F5")]),
        ('GRID', (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
        ('TOPPADDING', (0, 0), (-1, -1), 4),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
        ('LEFTPADDING', (0, 0), (-1, -1), 5),
        ('FONTNAME', (0, 0), (-1, 0), 'Helvetica-Bold'),
        ('ROWBACKGROUNDS', (0, 4), (-1, 4), [colors.HexColor("#E8F8F5")]),
    ]))
    return tbl


def build_products_table():
    header = [Paragraph(t, TABLE_HDR) for t in
              ["Blood Product", "Contents", "Storage", "Shelf Life", "Main Indications", "ABO Compat"]]
    rows = [
        ["pRBC", "Red cells in additive solution", "1–6°C", "42 days",
         "Anemia, acute blood loss,\nsickle cell, hemolysis", "Required (major)"],
        ["FFP", "All coag factors, fibrinogen,\nvWF, protein C/S", "–18°C frozen\nThawed: 1–6°C", "1 year frozen\n24h thawed",
         "Multiple factor deficiency,\nwarfarin reversal (if no PCC),\nMTP, TTP", "Preferred (minor)"],
        ["Cryoprecipitate", "Fibrinogen, vWF,\nFactor VIII, XIII", "–18°C frozen", "1 year frozen\n6h pooled thawed",
         "Hypofibrinogenemia (<150 mg/dL)\nOB hemorrhage, DIC, cardiac surgery", "Not required (adults)"],
        ["Platelets", "Platelets in plasma or\nadditive solution", "20–24°C\n(agitated)", "5 days",
         "Plt <10K (prophylactic)\nPlt <50K (procedure)\nActive bleeding with thrombocytopenia", "Preferred"],
        ["Granulocytes", "WBC concentrate", "20–24°C", "24 hours",
         "Severe neutropenia with\nlife-threatening infection", "Required;\nMUST irradiate"],
    ]
    data = [header]
    for row in rows:
        data.append([Paragraph(str(c), TABLE_CELL) for c in row])
    tbl = Table(data, colWidths=[28*mm, 38*mm, 24*mm, 22*mm, 47*mm, 25*mm])
    tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), TEAL),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [LIGHT_TEAL, WHITE, LIGHT_TEAL, WHITE, LIGHT_TEAL]),
        ('GRID', (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
        ('TOPPADDING', (0, 0), (-1, -1), 4),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
        ('LEFTPADDING', (0, 0), (-1, -1), 4),
        ('FONTNAME', (0, 1), (0, -1), 'Helvetica-Bold'),
    ]))
    return tbl


def build_reactions_table():
    header = [Paragraph(t, TABLE_HDR) for t in
              ["Reaction", "Timing", "Key Features", "Risk/Unit", "Management"]]
    rows = [
        ["Febrile Nonhemolytic\n(FNHTR)", "During / ≤4h",
         "Fever ≥1°C rise\nChills, rigors\nNO hemolysis",
         "~1:1,100", "Stop Tx → rule out hemolysis\nAntipyretics → restart if OK\nPrevent: leukoreduction"],
        ["Allergic (mild)", "During / ≤4h",
         "Urticaria, pruritus\nFlushing",
         "~1:100–1,200", "Antihistamine\nMay restart (slower rate)\nPrevent: antihistamine premedication"],
        ["Anaphylaxis\n(IgA deficient)", "During / ≤4h",
         "Hypotension, stridor\nBronchospasm, shock",
         "~1:20,000–50,000", "STOP. Epinephrine\nH1-blocker, corticosteroids\nIgA-deficient or washed units"],
        ["Acute Hemolytic\n(AHTR)", "During / ≤24h",
         "Fever, back pain\nHemoglobinuria\nHypotension, DIC",
         "~1:6,000–110,000\nFatal: ~1:100,000", "STOP immediately\nSaline, maintain urine output\nTreat DIC\nRepeat ABO/DAT\nFDA report"],
        ["TRALI", "≤6h post-Tx",
         "Hypoxia, bilateral CXR\ninfiltrates\nNO hypertension",
         "~1:5,000–140,000", "Supportive, O2, ventilate\nNO diuretics\nUsually resolves 48–96h"],
        ["TACO", "During / ≤12h",
         "Hypertension\nDyspnea, orthopnea\nElevated BNP",
         "~1:9,000", "Slow/stop Tx, sit upright\nO2, furosemide\nBNP/NT-proBNP confirms"],
        ["Delayed Hemolytic\n(DHTR)", "5–14 days",
         "Unexpected Hb fall\nMixed-field DAT\nBilirubinemia",
         "~1:3,000–32,000", "Identify antibody\nAntigen-negative units\nUsually self-limiting"],
        ["Bacterial Sepsis", "During / ≤1h",
         "High fever, rigors\nHypotension, shock",
         "Plt: ~1:25,000\nRBC: ~1:250,000", "STOP, blood cultures\nBroad-spectrum antibiotics\nICU support"],
        ["TA-GvHD", "8–10 days",
         "Fever, rash, diarrhea\nPancytopenia (BM failure)",
         "<1:10,000,000\nFatality ~90%", "Supportive (no effective Tx)\nPREVENT with irradiation"],
    ]
    data = [header]
    bgs = []
    for row in rows:
        data.append([Paragraph(str(c), TABLE_CELL) for c in row])
    
    row_bgs = [LIGHT_BLUE, WHITE, LIGHT_RED, colors.HexColor("#FDEDEC"),
               LIGHT_ORANGE, LIGHT_TEAL, LIGHT_BLUE, colors.HexColor("#FDEDEC"), LIGHT_ORANGE]
    
    tbl = Table(data, colWidths=[32*mm, 20*mm, 44*mm, 28*mm, 54*mm])
    tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), MED_RED),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [LIGHT_BLUE, WHITE, LIGHT_RED, colors.HexColor("#FDEDEC"),
                                               LIGHT_ORANGE, LIGHT_TEAL, LIGHT_BLUE,
                                               colors.HexColor("#FDEDEC"), LIGHT_ORANGE]),
        ('GRID', (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
        ('TOPPADDING', (0, 0), (-1, -1), 4),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
        ('LEFTPADDING', (0, 0), (-1, -1), 4),
        ('FONTNAME', (0, 1), (0, -1), 'Helvetica-Bold'),
        ('FONTNAME', (0, 4), (0, 5), 'Helvetica-Bold'),
    ]))
    return tbl


def build_thresholds_table():
    header = [Paragraph(t, TABLE_HDR) for t in
              ["Patient Population", "Hb Threshold (g/dL)", "Notes"]]
    rows = [
        ["Stable, non-cardiac ICU", "< 7 g/dL", "Restrictive strategy; lower mortality vs liberal"],
        ["Stable surgical patients", "< 7–8 g/dL", "Permit Hb 7-8 in most elective surgery"],
        ["GI bleeding (no CAD)", "< 8 g/dL", "Restrictive reduces rebleeding & mortality"],
        ["Portal HTN bleeding", "7–8 g/dL", "Avoid overtransfusion — worsens portal pressure"],
        ["Known/symptomatic CAD", "> 9 g/dL target", "Liberal threshold; cardiac ischemia must resolve"],
        ["Symptomatic anemia (any)", "Based on symptoms", "Dyspnea, angina, presyncope = transfuse"],
        ["Platelets - prophylaxis", "< 10,000/µL", "< 20K with fever; < 50K before procedure"],
        ["Neurosurgery / eye Sx", "Plt < 100,000/µL", "Higher platelet threshold"],
        ["FFP (active bleeding)", "INR > 1.5–2.0", "Only with active bleeding; not for routine correction"],
        ["Cryoprecipitate", "Fibrinogen < 150–200 mg/dL", "With active bleeding; obstetric threshold may be higher"],
    ]
    data = [header]
    for row in rows:
        data.append([Paragraph(str(c), TABLE_CELL_BOLD if 'Plt' in row[0] or row[0].startswith('Stable') else TABLE_CELL) for c in row])
    
    tbl = Table(data, colWidths=[55*mm, 40*mm, 89*mm])
    tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), DARK_BLUE),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [LIGHT_BLUE, WHITE] * 6),
        ('GRID', (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
        ('TOPPADDING', (0, 0), (-1, -1), 4),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
        ('LEFTPADDING', (0, 0), (-1, -1), 5),
        ('FONTNAME', (0, 1), (0, -1), 'Helvetica-Bold'),
        ('BACKGROUND', (0, 7), (-1, 7), colors.HexColor("#D5EFF7")),
        ('BACKGROUND', (0, 8), (-1, 8), colors.HexColor("#FEF9E7")),
        ('BACKGROUND', (0, 9), (-1, 9), colors.HexColor("#FEF9E7")),
    ]))
    return tbl


def build_modifications_table():
    header = [Paragraph(t, TABLE_HDR) for t in
              ["Modification", "Process", "Prevents / Achieves", "Key Indications"]]
    rows = [
        ["Leukoreduction\n(Leukodepleted)", "Filter removes WBCs\n(standard in most blood banks)",
         "Prevents FNHTR, reduces CMV\ntransmission, reduces HLA\nalloimmunization",
         "All cellular products (standard)\nHLA-sensitized patients\nChronic transfusion"],
        ["Irradiation\n(Gamma / X-ray)", "Inactivates donor T-lymphocytes",
         "Prevents TA-GvHD\n(fatality ~90%)",
         "Immunocompromised (HSCT, congenital\nimmunodeficiency), directed (family)\ndonations, HLA-matched platelets,\nfludarabine/cladribine therapy"],
        ["CMV-Negative\n(Seronegative)", "Donors tested CMV IgG negative",
         "Prevents CMV transmission in\nhigh-risk patients",
         "CMV-neg immunocompromised patients\nCMV-neg pregnant women\n(Leukoreduced blood is CMV-safe equivalent)"],
        ["Washed RBC/Plt", "Saline washing removes\nplasma proteins",
         "Removes IgA, allergens\nReduces allergic reactions",
         "IgA-deficient patients with anti-IgA\nSevere recurrent allergic reactions"],
        ["Irradiated +\nLeukoreduced", "Both modifications applied",
         "Prevents both TA-GvHD\nand CMV/FNHTR",
         "All immunocompromised patients\nIntrauterine transfusions (IUT)"],
    ]
    data = [header]
    for row in rows:
        data.append([Paragraph(str(c), TABLE_CELL) for c in row])
    
    tbl = Table(data, colWidths=[33*mm, 42*mm, 45*mm, 64*mm])
    tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), colors.HexColor("#6C3483")),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [colors.HexColor("#F5EEF8"), WHITE,
                                               colors.HexColor("#F5EEF8"), WHITE,
                                               colors.HexColor("#EAF2FF")]),
        ('GRID', (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
        ('TOPPADDING', (0, 0), (-1, -1), 4),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
        ('LEFTPADDING', (0, 0), (-1, -1), 5),
        ('FONTNAME', (0, 1), (0, -1), 'Helvetica-Bold'),
    ]))
    return tbl


# ─── Cover Page ───────────────────────────────────────────────────────────────
class CoverPage(Flowable):
    def __init__(self):
        super().__init__()
        self.width = W - 30*mm
        self.height = 120*mm

    def draw(self):
        c = self.canv
        # Background gradient simulation
        c.setFillColor(DARK_BLUE)
        c.roundRect(0, 0, self.width, self.height, 8*mm, fill=1, stroke=0)
        # Decorative red strip
        c.setFillColor(MED_RED)
        c.rect(0, self.height - 18*mm, self.width, 18*mm, fill=1, stroke=0)
        # Red circle decoration
        c.setFillColor(colors.HexColor("#3D6B99"))
        c.circle(self.width - 20*mm, 20*mm, 30*mm, fill=1, stroke=0)
        c.setFillColor(colors.HexColor("#2A5580"))
        c.circle(self.width - 15*mm, 15*mm, 18*mm, fill=1, stroke=0)
        # Gold accent line
        c.setFillColor(GOLD)
        c.rect(12*mm, self.height - 18*mm - 3*mm, self.width - 24*mm, 3*mm, fill=1, stroke=0)
        # Title
        c.setFillColor(WHITE)
        c.setFont('Helvetica-Bold', 22)
        c.drawString(14*mm, self.height - 13*mm, "Blood Transfusion Protocols")
        c.setFont('Helvetica-Bold', 16)
        c.setFillColor(GOLD)
        c.drawString(14*mm, self.height - 38*mm, "Clinical Reference & Reaction Flowcharts")
        c.setFillColor(colors.HexColor("#AED6F1"))
        c.setFont('Helvetica', 10)
        c.drawString(14*mm, self.height - 52*mm, "Blood Products  |  Transfusion Thresholds  |  ABO Compatibility")
        c.drawString(14*mm, self.height - 63*mm, "Transfusion Reactions  |  Massive Transfusion Protocol  |  Special Modifications")
        # Bottom
        c.setFillColor(colors.HexColor("#AED6F1"))
        c.setFont('Helvetica', 9)
        c.drawString(14*mm, 12*mm, "Based on: Tietz Lab Medicine 7e | Goldman-Cecil Medicine | Miller's Anesthesia 10e | Quick Compendium 5e")
        c.setFillColor(GOLD)
        c.drawRightString(self.width - 8*mm, 12*mm, "July 2026")

    def wrap(self, avW, avH):
        return self.width, self.height


# ─── Build Document ───────────────────────────────────────────────────────────
def build_pdf():
    doc = SimpleDocTemplate(
        OUTPUT_PATH,
        pagesize=A4,
        leftMargin=15*mm, rightMargin=15*mm,
        topMargin=15*mm, bottomMargin=22*mm,
        title="Blood Transfusion Protocols & Reference",
        author="Orris Medical Assistant",
        subject="Blood Transfusion Clinical Reference"
    )

    story = []
    S = Spacer

    # ── Cover ──
    story.append(CoverPage())
    story.append(S(1, 8*mm))

    # TOC-like summary box
    toc_data = [
        [Paragraph("📋  Contents", ParagraphStyle('toc_hdr', fontName='Helvetica-Bold',
                   fontSize=10, textColor=DARK_BLUE, leading=14))],
        [Paragraph(
            "<font color='#2E86C1'>1.</font> Blood Products &amp; Storage  &nbsp;&nbsp;"
            "<font color='#2E86C1'>2.</font> ABO/Rh Compatibility  &nbsp;&nbsp;"
            "<font color='#2E86C1'>3.</font> Transfusion Thresholds<br/>"
            "<font color='#2E86C1'>4.</font> pRBC Decision Flowchart  &nbsp;&nbsp;"
            "<font color='#2E86C1'>5.</font> Transfusion Reaction Flowchart  &nbsp;&nbsp;"
            "<font color='#2E86C1'>6.</font> Reaction Reference Table<br/>"
            "<font color='#2E86C1'>7.</font> Massive Transfusion Protocol  &nbsp;&nbsp;"
            "<font color='#2E86C1'>8.</font> Special Blood Modifications  &nbsp;&nbsp;"
            "<font color='#2E86C1'>9.</font> Key Tests &amp; Concepts",
            ParagraphStyle('toc_body', fontName='Helvetica', fontSize=8.5,
                           textColor=DARK_GREY, leading=14)
        )]
    ]
    toc_tbl = Table(toc_data, colWidths=[W - 30*mm])
    toc_tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, -1), LIGHT_BLUE),
        ('BOX', (0, 0), (-1, -1), 1.5, MED_BLUE),
        ('TOPPADDING', (0, 0), (-1, -1), 6),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 6),
        ('LEFTPADDING', (0, 0), (-1, -1), 10),
    ]))
    story.append(toc_tbl)
    story.append(PageBreak())

    # ── Section 1: Blood Products ──
    story.append(SectionHeader("1  Blood Products & Storage", TEAL))
    story.append(S(1, 3*mm))
    story.append(build_products_table())
    story.append(S(1, 3*mm))
    story.append(Paragraph(
        "<b>Key Points:</b> Each pRBC unit raises Hb by ~1 g/dL in an average adult. Platelets are stored at room temperature "
        "on an agitator — highest bacterial contamination risk. FFP must be ABO compatible (plasma contains antibodies). "
        "Cryoprecipitate is the preferred fibrinogen source; NOT interchangeable with FFP.",
        BODY_STYLE))
    story.append(S(1, 5*mm))

    # ── Section 2: ABO Compatibility ──
    story.append(SectionHeader("2  ABO & Rh Compatibility", DARK_BLUE))
    story.append(S(1, 3*mm))
    story.append(build_abo_table())
    story.append(S(1, 3*mm))
    story.append(BoxedNote(
        "EMERGENCY: Group O pRBCs (O-negative for females of childbearing potential) + Group AB plasma before type known",
        bg=LIGHT_BLUE, border=MED_BLUE, icon="E"))
    story.append(S(1, 3*mm))
    story.append(Paragraph(
        "<b>Rh(D):</b> D-negative females of childbearing age MUST receive D-negative pRBCs to prevent anti-D formation "
        "(risk ~10–20% per D+ unit), which can cause haemolytic disease of the fetus/newborn (HDN). "
        "Males and post-menopausal females can receive D+ components if D- is scarce. "
        "<b>Group A plasma</b> is increasingly used in MTP due to scarcity of AB (only 4% of population).",
        BODY_STYLE))
    story.append(S(1, 5*mm))

    # ── Section 3: Thresholds ──
    story.append(SectionHeader("3  Evidence-Based Transfusion Thresholds", DARK_BLUE))
    story.append(S(1, 3*mm))
    story.append(build_thresholds_table())
    story.append(S(1, 3*mm))
    story.append(Paragraph(
        "<b>Restrictive strategy (Hb threshold 7–8 g/dL)</b> is associated with lower all-cause mortality and rebleeding "
        "rates in RCTs for GI bleeding. <b>One-unit-at-a-time</b> transfusion with reassessment is recommended. "
        "Healthy volunteers can tolerate Hb as low as 5.1 g/dL short-term.",
        BODY_STYLE))
    story.append(PageBreak())

    # ── Section 4: pRBC Decision Flowchart ──
    story.append(SectionHeader("4  pRBC Transfusion Decision Flowchart", DARK_BLUE))
    story.append(S(1, 4*mm))
    story.append(build_prbc_flowchart())
    story.append(S(1, 2*mm))
    story.append(Paragraph(
        "Fig. 1 - pRBC transfusion decision algorithm. In life-threatening hemorrhage, use uncrossmatched "
        "group O blood while type and screen is being performed. For stable patients, base decision on Hb thresholds above.",
        CAPTION))
    story.append(S(1, 5*mm))

    # Pretransfusion testing box
    story.append(SectionHeader("5  Pretransfusion Testing", TEAL))
    story.append(S(1, 3*mm))
    pre_data = [
        [Paragraph("Test", TABLE_HDR), Paragraph("What It Does", TABLE_HDR),
         Paragraph("When Valid", TABLE_HDR), Paragraph("Key Point", TABLE_HDR)],
        [Paragraph("Type & Screen\n(T&S)", TABLE_CELL_BOLD),
         Paragraph("ABO/D typing + antibody screen\n(unexpected alloantibodies)", TABLE_CELL),
         Paragraph("No recent Tx/pregnancy:\nup to 1 month\nRecent Tx/pregnancy:\n3 days only", TABLE_CELL),
         Paragraph("Most hemolytic reactions = clerical/\nID errors, not testing failures", TABLE_CELL)],
        [Paragraph("Type & Crossmatch", TABLE_CELL_BOLD),
         Paragraph("T&S + select and reserve\nspecific RBC units for patient", TABLE_CELL),
         Paragraph("Same as T&S", TABLE_CELL),
         Paragraph("Electronic crossmatch if 2 concordant\nABO types & negative antibody screen", TABLE_CELL)],
        [Paragraph("DAT\n(Direct Coombs)", TABLE_CELL_BOLD),
         Paragraph("Detects Ab/complement bound\nto patient's own RBCs", TABLE_CELL),
         Paragraph("Any time", TABLE_CELL),
         Paragraph("Positive in: AIHA, AHTR, HDN,\ndrug-induced hemolysis", TABLE_CELL)],
        [Paragraph("IAT\n(Indirect Coombs)", TABLE_CELL_BOLD),
         Paragraph("Detects free antibodies in\npatient serum vs donor RBCs", TABLE_CELL),
         Paragraph("Any time", TABLE_CELL),
         Paragraph("Used for antibody screening,\nidentification, and crossmatch", TABLE_CELL)],
    ]
    pre_tbl = Table(pre_data, colWidths=[30*mm, 52*mm, 38*mm, 64*mm])
    pre_tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), TEAL),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [LIGHT_TEAL, WHITE, LIGHT_TEAL, WHITE]),
        ('GRID', (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
        ('TOPPADDING', (0, 0), (-1, -1), 4),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
        ('LEFTPADDING', (0, 0), (-1, -1), 5),
    ]))
    story.append(pre_tbl)
    story.append(PageBreak())

    # ── Section 6: Reaction Flowchart ──
    story.append(SectionHeader("6  Transfusion Reaction Management Flowchart", MED_RED))
    story.append(S(1, 4*mm))
    story.append(build_reaction_flowchart())
    story.append(S(1, 2*mm))
    story.append(Paragraph(
        "Fig. 2 - Algorithm for managing suspected transfusion reactions. "
        "TRALI = non-cardiogenic pulmonary edema (no diuretics). TACO = cardiogenic overload (give diuretics). "
        "Key distinction: TACO has hypertension + elevated BNP; TRALI has hypotension/normotension, no BNP rise.",
        CAPTION))
    story.append(PageBreak())

    # ── Section 7: Reactions Table ──
    story.append(SectionHeader("7  Transfusion Reactions Reference Table", MED_RED))
    story.append(S(1, 3*mm))
    story.append(build_reactions_table())
    story.append(S(1, 3*mm))
    story.append(Paragraph(
        "<b>Most common reaction:</b> FNHTR (~1:1,100). "
        "<b>Most dangerous acute reaction:</b> AHTR (usually ABO incompatibility from clerical error). "
        "<b>Leading cause of transfusion death (USA):</b> TRALI. "
        "<b>Highest preventable mortality:</b> TA-GvHD (prevent with irradiation).",
        BODY_STYLE))
    story.append(PageBreak())

    # ── Section 8: MTP ──
    story.append(SectionHeader("8  Massive Transfusion Protocol (MTP)", MED_RED))
    story.append(S(1, 4*mm))
    story.append(build_mtp_flowchart())
    story.append(S(1, 3*mm))
    story.append(Paragraph(
        "Fig. 3 - Massive Transfusion Protocol overview. The 1:1:1 ratio (FFP:Plt:pRBC) is supported by the "
        "PROPPR trial. Communicate clearly with blood bank — activate and deactivate MTP explicitly. "
        "Monitor: iCa²⁺ (citrate chelation), K⁺ (stored RBC), temperature (use blood warmers), and coagulation.",
        CAPTION))
    story.append(S(1, 5*mm))

    # Lethal triad box
    triad_data = [
        [Paragraph("THE LETHAL TRIAD OF MASSIVE HEMORRHAGE", ParagraphStyle('triad_hdr',
          fontName='Helvetica-Bold', fontSize=10, textColor=WHITE, alignment=TA_CENTER))],
        [Table([[
            Paragraph("HYPOTHERMIA\n< 35°C\n→ Use blood warmers\nwarm IV fluids\nBair Hugger blankets",
                       ParagraphStyle('triad', fontName='Helvetica-Bold', fontSize=8.5,
                                      textColor=DARK_BLUE, alignment=TA_CENTER, leading=13)),
            Paragraph("ACIDOSIS\npH < 7.35\n→ Balanced MTP\nBuffer with bicarb\nif persistent",
                       ParagraphStyle('triad', fontName='Helvetica-Bold', fontSize=8.5,
                                      textColor=DARK_BLUE, alignment=TA_CENTER, leading=13)),
            Paragraph("COAGULOPATHY\nDilutional / consumptive\n→ Balanced ratio\nAvoid pRBC-only\nCheck TEG/ROTEM",
                       ParagraphStyle('triad', fontName='Helvetica-Bold', fontSize=8.5,
                                      textColor=DARK_BLUE, alignment=TA_CENTER, leading=13)),
        ], colWidths=[52*mm, 52*mm, 52*mm])],
    ]
    triad_tbl = Table(triad_data, colWidths=[W - 30*mm])
    triad_tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (0, 0), MED_RED),
        ('BACKGROUND', (0, 1), (0, 1), LIGHT_ORANGE),
        ('BOX', (0, 0), (-1, -1), 1.5, MED_RED),
        ('TOPPADDING', (0, 0), (-1, -1), 6),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 6),
        ('LEFTPADDING', (0, 0), (-1, -1), 6),
    ]))
    story.append(triad_tbl)
    story.append(PageBreak())

    # ── Section 9: Special Modifications ──
    story.append(SectionHeader("9  Special Blood Product Modifications", colors.HexColor("#6C3483")))
    story.append(S(1, 3*mm))
    story.append(build_modifications_table())
    story.append(S(1, 5*mm))

    # ── Section 10: Key Tests & Concepts ──
    story.append(SectionHeader("10  Key Blood Bank Concepts for Clinicians", DARK_BLUE))
    story.append(S(1, 3*mm))

    concepts = [
        ("Platelet Refractoriness",
         "Failure to achieve expected platelet increment. Check CCI at 1 hour post-transfusion: "
         "CCI < 5,000–7,500 = immune cause (HLA alloantibodies most common). "
         "CCI normal at 1h but drops later = non-immune (DIC, sepsis, splenomegaly). "
         "Immune: provide HLA-matched apheresis platelets."),
        ("Delayed Serologic Transfusion Reaction (DSTR)",
         "New alloantibody detected after transfusion WITHOUT hemolysis. More common than DHTR (3:1 ratio). "
         "Most commonly implicated antigens: Kidd (Jk), E, c (Rh), Kell, Duffy. "
         "Kidd antibodies can cause severe intravascular hemolysis."),
        ("IgA Deficiency & Anaphylaxis",
         "Affects 1 in 700 people. Patients with anti-IgA antibodies are at risk for anaphylaxis to blood products. "
         "Test for IgA deficiency in any patient with severe allergic transfusion reaction. "
         "Management: IgA-deficient donor units OR washed products."),
        ("Autologous Transfusion Options",
         "1) Preoperative autologous donation (PAD): donate weeks before elective surgery. "
         "2) Acute normovolemic hemodilution (ANH): remove blood at surgery start, replace with crystalloid, reinfuse later. "
         "3) Cell salvage: contraindicated in cancer surgery and infected fields."),
        ("Transfusion in Jehovah's Witnesses",
         "Refuse allogeneic blood on religious grounds. Alternatives: cell salvage (if accepted in closed circuit), "
         "EPO + iron preoperatively, fibrin glue, minimize iatrogenic blood loss. "
         "Always obtain informed refusal. Ethics committee for unconscious patients."),
        ("Hyperhemolysis in Sickle Cell Disease",
         "Rare but life-threatening: both donor AND patient's own cells are destroyed post-transfusion. "
         "Paradox: further transfusion may worsen hemolysis. Use extended phenotype-matched RBCs. "
         "Exchange transfusion (apheresis) preferred for stroke prevention/treatment."),
    ]

    for title, text in concepts:
        cdata = [[
            Paragraph(title, TABLE_CELL_BOLD),
            Paragraph(text, TABLE_CELL),
        ]]
        ctbl = Table(cdata, colWidths=[45*mm, 139*mm])
        ctbl.setStyle(TableStyle([
            ('BACKGROUND', (0, 0), (0, 0), LIGHT_BLUE),
            ('BACKGROUND', (1, 0), (1, 0), WHITE),
            ('BOX', (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
            ('INNERGRID', (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
            ('TOPPADDING', (0, 0), (-1, -1), 5),
            ('BOTTOMPADDING', (0, 0), (-1, -1), 5),
            ('LEFTPADDING', (0, 0), (-1, -1), 6),
            ('VALIGN', (0, 0), (-1, -1), 'TOP'),
        ]))
        story.append(ctbl)
        story.append(S(1, 1*mm))

    story.append(S(1, 6*mm))

    # ── Final Reference Box ──
    final_data = [[
        Paragraph(
            "<b>Sources &amp; References</b><br/>"
            "Tietz Textbook of Laboratory Medicine, 7th Edition (Chapters 92, 93) &nbsp;|&nbsp; "
            "Goldman-Cecil Medicine, International Edition (Chapter 162) &nbsp;|&nbsp; "
            "Quick Compendium of Clinical Pathology, 5th Edition (Chapter 2.8) &nbsp;|&nbsp; "
            "Miller's Anesthesia, 10th Edition (Chapter 45) &nbsp;|&nbsp; "
            "Rosen's Emergency Medicine, 10th Edition",
            ParagraphStyle('refs', fontName='Helvetica', fontSize=7.5, textColor=MID_GREY,
                            leading=12, alignment=TA_CENTER)
        )
    ]]
    final_tbl = Table(final_data, colWidths=[W - 30*mm])
    final_tbl.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, -1), LIGHT_GREY),
        ('BOX', (0, 0), (-1, -1), 1, MID_GREY),
        ('TOPPADDING', (0, 0), (-1, -1), 8),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 8),
        ('LEFTPADDING', (0, 0), (-1, -1), 10),
    ]))
    story.append(final_tbl)

    doc.build(story, onFirstPage=on_first_page, onLaterPages=on_page)
    print(f"PDF created: {OUTPUT_PATH}")
    return OUTPUT_PATH


if __name__ == '__main__':
    build_pdf()

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/blood-transfusion-pdf/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/blood-transfusion-pdf/generate_pdf.py'