from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
import subprocess, json, base64
from io import BytesIO

# ─── Colour palette ───────────────────────────────────────────────────────────
DARK_RED   = RGBColor(0xB0, 0x1C, 0x1C)   # header bars / title
MED_RED    = RGBColor(0xCC, 0x3A, 0x3A)
LIGHT_RED  = RGBColor(0xF9, 0xD0, 0xD0)   # slide background tint
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
DARK_GRAY  = RGBColor(0x23, 0x23, 0x23)
MID_GRAY   = RGBColor(0x55, 0x55, 0x55)
LIGHT_GRAY = RGBColor(0xF2, 0xF2, 0xF2)
GOLD       = RGBColor(0xF5, 0xA6, 0x23)
TEAL       = RGBColor(0x1A, 0x7A, 0x8A)
LIGHT_TEAL = RGBColor(0xD4, 0xF0, 0xF4)

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]   # fully blank

# ─── Helper utilities ─────────────────────────────────────────────────────────

def add_rect(slide, x, y, w, h, fill_color=None, border_color=None, border_pt=0):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.line.width = Pt(border_pt)
    if fill_color:
        shape.fill.solid()
        shape.fill.fore_color.rgb = fill_color
    else:
        shape.fill.background()
    if border_color and border_pt > 0:
        shape.line.color.rgb = border_color
    else:
        shape.line.fill.background()
    return shape

def add_text(slide, text, x, y, w, h,
             font_size=18, bold=False, color=DARK_GRAY, align=PP_ALIGN.LEFT,
             italic=False, wrap=True, v_anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = v_anchor
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = "Calibri"
    return tf

def add_multi_para(slide, bullets, x, y, w, h,
                   font_size=15, color=DARK_GRAY, bullet_char="●",
                   bold_first=False):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    first = True
    for i, b in enumerate(bullets):
        if i == 0:
            p = tf.paragraphs[0]
        else:
            p = tf.add_paragraph()
        p.space_before = Pt(3)
        if isinstance(b, tuple):
            label, rest = b
            run = p.add_run()
            run.text = f"{bullet_char} {label}"
            run.font.bold = True
            run.font.size = Pt(font_size)
            run.font.color.rgb = DARK_RED
            run.font.name = "Calibri"
            run2 = p.add_run()
            run2.text = f" {rest}"
            run2.font.bold = False
            run2.font.size = Pt(font_size)
            run2.font.color.rgb = color
            run2.font.name = "Calibri"
        else:
            run = p.add_run()
            run.text = f"{bullet_char} {b}"
            run.font.bold = bold_first and first
            run.font.size = Pt(font_size)
            run.font.color.rgb = color
            run.font.name = "Calibri"
        first = False
    return tf

def section_header(slide, title, subtitle=""):
    """Full-width red header bar at top."""
    add_rect(slide, 0, 0, 13.333, 1.1, fill_color=DARK_RED)
    add_text(slide, title, 0.3, 0.05, 12.7, 0.9,
             font_size=34, bold=True, color=WHITE, align=PP_ALIGN.LEFT,
             v_anchor=MSO_ANCHOR.MIDDLE)
    if subtitle:
        add_rect(slide, 0, 1.1, 13.333, 0.35, fill_color=MED_RED)
        add_text(slide, subtitle, 0.3, 1.1, 12.7, 0.35,
                 font_size=14, bold=False, color=WHITE, align=PP_ALIGN.LEFT,
                 v_anchor=MSO_ANCHOR.MIDDLE)

def content_header(slide, title):
    add_rect(slide, 0, 0, 13.333, 0.75, fill_color=DARK_RED)
    add_text(slide, title, 0.3, 0, 12.7, 0.75,
             font_size=26, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
    # thin gold underline
    add_rect(slide, 0, 0.75, 13.333, 0.06, fill_color=GOLD)

def footer(slide, text="Bailey & Love's Surgery, 28th Ed  |  Pye's Surgical Handicraft, 22nd Ed"):
    add_rect(slide, 0, 7.25, 13.333, 0.25, fill_color=DARK_RED)
    add_text(slide, text, 0.3, 7.25, 12.7, 0.25,
             font_size=9, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

def light_bg(slide):
    add_rect(slide, 0, 0, 13.333, 7.5, fill_color=LIGHT_GRAY)

def add_info_box(slide, title, bullets, x, y, w, h,
                 header_color=TEAL, body_color=LIGHT_TEAL):
    add_rect(slide, x, y, w, 0.45, fill_color=header_color)
    add_text(slide, title, x+0.1, y, w-0.15, 0.45,
             font_size=14, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, x, y+0.45, w, h-0.45, fill_color=body_color,
             border_color=header_color, border_pt=1)
    add_multi_para(slide, bullets, x+0.1, y+0.5, w-0.2, h-0.6,
                   font_size=13, color=DARK_GRAY)

def draw_table(slide, headers, rows, x, y, col_widths, row_height=0.42):
    col_x = x
    for i, h in enumerate(headers):
        add_rect(slide, col_x, y, col_widths[i], row_height, fill_color=DARK_RED,
                 border_color=WHITE, border_pt=0.5)
        add_text(slide, h, col_x+0.05, y+0.03, col_widths[i]-0.1, row_height-0.06,
                 font_size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
                 v_anchor=MSO_ANCHOR.MIDDLE)
        col_x += col_widths[i]
    for ri, row in enumerate(rows):
        row_y = y + row_height*(ri+1)
        fill = LIGHT_GRAY if ri % 2 == 0 else WHITE
        col_x = x
        for ci, cell in enumerate(row):
            add_rect(slide, col_x, row_y, col_widths[ci], row_height,
                     fill_color=fill, border_color=MID_GRAY, border_pt=0.3)
            add_text(slide, cell, col_x+0.05, row_y+0.03,
                     col_widths[ci]-0.1, row_height-0.06,
                     font_size=12, color=DARK_GRAY,
                     align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
            col_x += col_widths[ci]

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 1  ─  Title slide
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
# Deep red full background
add_rect(slide, 0, 0, 13.333, 7.5, fill_color=DARK_RED)
# Decorative white band
add_rect(slide, 0, 5.6, 13.333, 0.08, fill_color=WHITE)
add_rect(slide, 0, 5.72, 13.333, 0.08, fill_color=GOLD)

# Blood drop SVG-like circle decoration (red circle with lighter fill)
add_rect(slide, 10.8, 0.8, 1.8, 2.8, fill_color=MED_RED)

add_text(slide, "BLOOD & BLOOD PRODUCTS", 0.6, 0.9, 10.0, 1.2,
         font_size=42, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
add_text(slide, "Transfusion Medicine in Surgical Practice",
         0.6, 2.15, 10.0, 0.7, font_size=24, bold=False, color=GOLD,
         align=PP_ALIGN.LEFT)

add_rect(slide, 0.6, 3.0, 8.5, 0.05, fill_color=WHITE)

topics = [
    "Introduction to Blood & Blood Products",
    "Indications & Appropriate Use",
    "Blood Transfusion Procedure & Precautions",
    "Complications of Blood Transfusion",
    "Prevention & Management of Complications"
]
for i, t in enumerate(topics):
    add_text(slide, f"  {i+1}.  {t}", 0.6, 3.2 + i*0.45, 9.5, 0.45,
             font_size=15, color=WHITE)

add_text(slide, "Reference: Bailey & Love's Short Practice of Surgery, 28th Ed\n"
                "                  Pye's Surgical Handicraft, 22nd Ed",
         0.6, 5.85, 10.0, 0.9, font_size=12, color=LIGHT_RED, italic=True)

footer(slide, "Blood Transfusion in Surgery  |  Bailey & Love 28e  |  Pye's Surgical Handicraft 22e")

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 2  ─  History of Blood Transfusion
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "History of Blood Transfusion")

history_data = [
    ("1492", "Pope Innocent VIII – first recorded transfusion (sheep blood); fatal"),
    ("1665", "Richard Lower – first successful canine-to-canine transfusion (Oxford)"),
    ("1667", "Jean-Baptiste Denis – successful sheep-to-human transfusion"),
    ("1818", "James Blundell – first successful human-to-human transfusion (postpartum haemorrhage)"),
    ("1901", "Karl Landsteiner – discovery of the ABO blood group system"),
    ("1914", "Albert Hustin – first non-direct transfusion using sodium citrate anticoagulant"),
    ("1926", "British Red Cross – instituted the world's first Blood Transfusion Service"),
    ("1939", "Rhesus system identified – recognized as major cause of transfusion reactions"),
]

# Timeline strip
add_rect(slide, 0.5, 1.0, 0.12, 6.0, fill_color=DARK_RED)
for i, (yr, desc) in enumerate(history_data):
    yy = 1.05 + i * 0.72
    # dot
    add_rect(slide, 0.38, yy + 0.08, 0.35, 0.35, fill_color=GOLD,
             border_color=DARK_RED, border_pt=1)
    add_text(slide, yr, 0.38, yy+0.02, 0.35, 0.4,
             font_size=11, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)
    add_text(slide, desc, 0.88, yy, 11.8, 0.65,
             font_size=14, color=DARK_GRAY, wrap=True)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 3  ─  Blood Collection & Screening
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Blood Collection & Screening")

add_rect(slide, 0.3, 0.9, 12.7, 0.45, fill_color=MED_RED)
add_text(slide, "Every unit of donated blood undergoes rigorous testing before use  (Bailey & Love, 28th Ed)",
         0.4, 0.9, 12.5, 0.45, font_size=13, color=WHITE, italic=True,
         v_anchor=MSO_ANCHOR.MIDDLE)

# Left column - donation details
add_info_box(slide, "Donation Standards (UK)",
    ["Up to 450 mL drawn per session",
     "Maximum 3 times per year per donor",
     "Donors pre-screened to protect both donor & recipient",
     "All units leukodepleted (precaution against vCJD; also reduces immunogenicity)"],
    0.3, 1.5, 6.0, 2.4)

# Right column - testing
add_info_box(slide, "Mandatory Testing per Unit",
    ["Hepatitis B surface antigen (HBsAg)",
     "Hepatitis C antibody (anti-HCV)",
     "HIV-1 & HIV-2 antibodies",
     "Syphilis serology",
     "ABO & Rhesus D blood grouping",
     "Irregular red cell antibody screen"],
    6.5, 1.5, 6.5, 2.4)

# Processing flow diagram
add_rect(slide, 0.3, 4.05, 12.7, 0.38, fill_color=DARK_RED)
add_text(slide, "Processing of Donated Blood into Components", 0.4, 4.05, 12.5, 0.38,
         font_size=14, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

boxes = [
    ("Whole Blood\n(450 mL)", 0.35, 4.5),
    ("Centrifuge", 2.55, 4.5),
    ("Red Cell\nConcentrate", 4.75, 4.5),
    ("Platelet\nConcentrate", 6.95, 4.5),
    ("Fresh Frozen\nPlasma (FFP)", 9.15, 4.5),
    ("Cryoprecipitate", 11.35, 4.5),
]
colors = [MED_RED, TEAL, DARK_RED, RGBColor(0x8A,0x1A,0x6E),
          RGBColor(0x1A,0x6E,0x3A), TEAL]
for (label, bx, by), col in zip(boxes, colors):
    add_rect(slide, bx, by, 1.9, 1.0, fill_color=col,
             border_color=WHITE, border_pt=1)
    add_text(slide, label, bx+0.05, by+0.05, 1.8, 0.9,
             font_size=12, bold=True, color=WHITE,
             align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
    if bx < 11.35:
        add_text(slide, "→", bx+1.93, by+0.3, 0.45, 0.4,
                 font_size=16, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 4  ─  Blood Products: Types & Uses
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Blood Products – Types & Key Features")

product_data = [
    ("Whole Blood", "Rarely used in civilian practice\nContains all components incl. clotting factors\nAdvantage if fresh: coagulation factor-rich\nIndication: massive haemorrhage, military/trauma settings"),
    ("Packed Red Blood Cells\n(pRBC)", "Most commonly transfused product\nHaematocrit ≈ 55–75%\nStored up to 35 days at 2–6 °C\nIndication: symptomatic anaemia, periop blood loss"),
    ("Fresh Frozen Plasma\n(FFP)", "Contains all coagulation factors\nUsed within 4 h of thawing\nIndications: coagulopathy, liver failure, massive transfusion\nDose: 10–15 mL/kg"),
    ("Platelet Concentrate", "1 unit raises count by ≈ 5–10 × 10⁹/L\nPool of 4–6 donor units or single-donor apheresis\nIndications: thrombocytopenia, platelet dysfunction\nTransfuse when count < 50 × 10⁹/L (surgery)"),
    ("Cryoprecipitate", "Rich in fibrinogen, Factor VIII, vWF, Factor XIII\nUsed in: hypofibrinogenaemia, DIC, haemophilia A\nCritical in: massive haemorrhage with low fibrinogen"),
    ("Albumin & Colloids", "4.5–5% albumin: volume expansion\n20–25% albumin: hypoalbuminaemia\nNo coagulation factors; infection-free"),
]

cols = 3
rows_n = 2
card_w = 4.2
card_h = 2.7
start_x = 0.3
start_y = 0.95

for idx, (name, text) in enumerate(product_data):
    col_i = idx % cols
    row_i = idx // cols
    cx = start_x + col_i * (card_w + 0.12)
    cy = start_y + row_i * (card_h + 0.12)
    add_rect(slide, cx, cy, card_w, 0.42, fill_color=TEAL)
    add_text(slide, name, cx+0.08, cy, card_w-0.1, 0.42,
             font_size=13, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, cx, cy+0.42, card_w, card_h-0.42, fill_color=LIGHT_TEAL,
             border_color=TEAL, border_pt=0.5)
    add_text(slide, text, cx+0.1, cy+0.48, card_w-0.2, card_h-0.55,
             font_size=12, color=DARK_GRAY, wrap=True)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 5  ─  ABO & Rhesus Blood Groups
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "ABO & Rhesus Blood Group Systems")

# ABO table
abo_headers = ["Blood Group", "Antigens on RBC", "Antibodies in Serum", "Can Donate to", "Can Receive from"]
abo_rows = [
    ["A",  "A",     "Anti-B",         "A, AB",     "A, O"],
    ["B",  "B",     "Anti-A",         "B, AB",     "B, O"],
    ["AB", "A & B", "None",           "AB only",   "All groups"],
    ["O",  "None",  "Anti-A, Anti-B", "All groups","O only"],
]
draw_table(slide, abo_headers, abo_rows, 0.3, 0.95,
           [1.4, 1.8, 2.2, 2.2, 2.2], row_height=0.48)

add_rect(slide, 0.3, 3.3, 12.7, 0.38, fill_color=MED_RED)
add_text(slide, "Rhesus (Rh) System", 0.4, 3.3, 12.5, 0.38,
         font_size=16, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

rh_bullets = [
    "Rh+ (D antigen present): 85% of population",
    "Rh- individuals do NOT have anti-D naturally - sensitisation occurs on first exposure",
    "Rh- women of childbearing age: must receive Rh- blood to prevent haemolytic disease of the newborn (HDN)",
    "Anti-D immunoglobulin given within 72h after sensitising event (miscarriage, ectopic pregnancy, delivery)",
    "Cross-matching performed before every transfusion to detect incompatibilities",
]
add_multi_para(slide, rh_bullets, 0.4, 3.75, 12.4, 2.4, font_size=14)

add_rect(slide, 0.3, 6.2, 12.7, 0.62, fill_color=LIGHT_RED,
         border_color=DARK_RED, border_pt=1)
add_text(slide, "⚠  Universal Donor (O-): can donate to ALL  |  Universal Recipient (AB+): can receive from ALL\n"
                "   Cross-matching must ALWAYS be performed even in emergency where group-specific blood is used",
         0.45, 6.22, 12.4, 0.6, font_size=13, bold=True, color=DARK_RED)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 6  ─  Cross-Matching & Compatibility Testing
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Cross-Matching & Compatibility Testing")

steps = [
    ("1", "SAMPLE COLLECTION", "Patient blood sample clearly labelled with: Name, DOB, Hospital No., Date & Time, Signature of collector"),
    ("2", "BLOOD GROUPING", "ABO and Rh D typing of patient sample\nForward & reverse grouping performed"),
    ("3", "ANTIBODY SCREEN", "Indirect antiglobulin test (IAT) to detect irregular antibodies in patient serum"),
    ("4", "CROSS-MATCH", "Donor RBCs incubated with patient serum\nElectronic XM or serological XM performed\nFull compatibility confirmed before issue"),
    ("5", "ISSUE & LABELLING", "Blood issued with compatibility label\nMust match patient ID exactly before transfusion"),
]

for i, (num, title, desc) in enumerate(steps):
    bx = 0.3 + i * 2.56
    add_rect(slide, bx, 0.95, 2.4, 0.6, fill_color=DARK_RED,
             border_color=WHITE, border_pt=1)
    add_text(slide, f"Step {num}", bx+0.05, 0.95, 2.3, 0.3,
             font_size=11, bold=True, color=GOLD, align=PP_ALIGN.CENTER)
    add_text(slide, title, bx+0.05, 1.25, 2.3, 0.3,
             font_size=11, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(slide, bx, 1.55, 2.4, 2.4, fill_color=LIGHT_TEAL,
             border_color=TEAL, border_pt=0.5)
    add_text(slide, desc, bx+0.1, 1.6, 2.2, 2.3,
             font_size=12, color=DARK_GRAY, wrap=True)
    if i < 4:
        add_text(slide, "▶", bx+2.42, 1.65, 0.22, 0.4,
                 font_size=16, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)

# Emergency protocols
add_rect(slide, 0.3, 4.15, 12.7, 0.42, fill_color=MED_RED)
add_text(slide, "Emergency Blood Protocols", 0.4, 4.15, 12.5, 0.42,
         font_size=15, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

em_boxes = [
    ("Group-Specific\n(10 min)", "ABO & RhD compatible but not fully cross-matched\nUsed when patient bleeding severely"),
    ("Type & Screen\n(30 min)", "Full ABO/Rh + antibody screen\nNo donor blood pre-selected until needed"),
    ("O Negative\n(Immediate)", "Universal donor RBCs\nFor immediate life-threatening haemorrhage\nSwitched to patient-specific blood as soon as available"),
    ("Full X-Match\n(45–60 min)", "Complete serological compatibility test\nGold standard in elective/semi-elective setting"),
]

for i, (em_title, em_desc) in enumerate(em_boxes):
    ex = 0.35 + i * 3.22
    add_rect(slide, ex, 4.65, 3.0, 0.45, fill_color=TEAL)
    add_text(slide, em_title, ex+0.05, 4.65, 2.9, 0.45,
             font_size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, ex, 5.1, 3.0, 1.8, fill_color=WHITE,
             border_color=TEAL, border_pt=0.5)
    add_text(slide, em_desc, ex+0.1, 5.15, 2.8, 1.7,
             font_size=12, color=DARK_GRAY, wrap=True)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 7  ─  Indications for Blood Transfusion
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Indications for Blood Transfusion")

add_rect(slide, 0.3, 0.9, 12.7, 0.42, fill_color=TEAL)
add_text(slide, "\"Blood transfusions should be avoided if possible\" — Bailey & Love 28th Ed",
         0.4, 0.9, 12.5, 0.42, font_size=13, bold=False, italic=True,
         color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

# Three main indication boxes
ind_data = [
    ("1. ACUTE BLOOD LOSS",
     ["Replace circulating volume & maintain oxygen delivery",
      "Haemorrhage from trauma, surgery or GI bleeding",
      "Target: restore haemodynamic stability",
      "Initial crystalloid/colloid resuscitation may precede transfusion",
      "Examples: ruptured AAA (up to 9 units), major trauma, GI bleed"],
     DARK_RED),
    ("2. PERIOPERATIVE ANAEMIA",
     ["Ensure adequate O₂ delivery during surgery & recovery",
      "Pre-operative Hb optimisation preferred (IV iron/EPO)",
      "Intraoperative: triggered by Hb <7 g/dL or haemodynamic compromise",
      "Cell saver use reduces allogeneic transfusion",
      "Examples: colorectal resection, orthopaedic procedures"],
     TEAL),
    ("3. SYMPTOMATIC CHRONIC ANAEMIA",
     ["Without haemorrhage or impending surgery",
      "Anaemia of chronic disease (e.g. Crohn's, malignancy)",
      "Chronic bleeding: iron deficiency from Ca. caecum",
      "Only transfuse if symptomatic (SOB, chest pain, fatigue)",
      "Special: pre-renal transplant to enhance graft survival (immune modulation)"],
     RGBColor(0x1A, 0x6E, 0x3A)),
]

for i, (title, bullets, col) in enumerate(ind_data):
    bx = 0.3 + i * 4.35
    add_rect(slide, bx, 1.45, 4.15, 0.5, fill_color=col)
    add_text(slide, title, bx+0.1, 1.45, 4.0, 0.5,
             font_size=13, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, bx, 1.95, 4.15, 3.6, fill_color=WHITE,
             border_color=col, border_pt=1)
    add_multi_para(slide, bullets, bx+0.15, 2.0, 3.9, 3.5,
                   font_size=13, color=DARK_GRAY)

# Transfusion trigger box at bottom
add_rect(slide, 0.3, 5.65, 12.7, 0.38, fill_color=DARK_RED)
add_text(slide, "Transfusion Trigger (Bailey & Love Table 2.6)", 0.4, 5.65, 12.5, 0.38,
         font_size=15, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

draw_table(slide,
    ["Haemoglobin (g/dL)", "Clinical Indication", "Action"],
    [["< 6", "All patients", "Transfuse – will likely benefit"],
     ["6 – 8", "No bleeding or surgery", "Transfusion unlikely beneficial unless symptomatic"],
     ["> 8", "No risk factors", "No indication for transfusion"]],
    0.3, 6.05, [2.5, 5.5, 4.7], row_height=0.37)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 8  ─  Appropriate Use / Patient Blood Management
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Appropriate Use of Blood – Patient Blood Management (PBM)")

add_text(slide, "PBM is an evidence-based approach to optimise the use of blood and minimise transfusion.",
         0.4, 0.9, 12.5, 0.45, font_size=15, bold=True, italic=True, color=DARK_RED)

# Three pillars
pillar_data = [
    ("PILLAR 1\nOptimise Haemopoiesis",
     ["Detect & treat anaemia preoperatively",
      "IV/oral iron supplementation",
      "Erythropoiesis-stimulating agents (EPO) if indicated",
      "Treat nutritional deficiencies (B12, folate)",
      "Aim: Hb ≥ 13 g/dL before elective surgery"],
     DARK_RED),
    ("PILLAR 2\nMinimise Blood Loss",
     ["Meticulous haemostatic surgical technique",
      "Cell salvage (intra- & post-operative)",
      "Autologous pre-donation",
      "Antifibrinolytics: tranexamic acid (TXA)",
      "Topical haemostatics (fibrin sealants)",
      "Avoid NSAIDs / antiplatelet agents pre-op"],
     TEAL),
    ("PILLAR 3\nOptimise Anaemia Tolerance",
     ["Permissive anaemia: Hb trigger ≥ 6 g/dL in stable pts",
      "High flow oxygen therapy to maximise O₂ delivery",
      "Haemodynamic optimisation (fluids, vasopressors)",
      "Normovolaemia maintenance",
      "Avoid unnecessary phlebotomy",
      "Iron supplementation post-op"],
     RGBColor(0x5A, 0x22, 0x8A)),
]

for i, (title, bullets, col) in enumerate(pillar_data):
    bx = 0.3 + i * 4.35
    add_rect(slide, bx, 1.45, 4.15, 0.7, fill_color=col)
    add_text(slide, title, bx+0.1, 1.45, 4.0, 0.7,
             font_size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, bx, 2.15, 4.15, 3.75, fill_color=WHITE,
             border_color=col, border_pt=1)
    add_multi_para(slide, bullets, bx+0.15, 2.2, 3.9, 3.65,
                   font_size=13, color=DARK_GRAY)

add_rect(slide, 0.3, 6.05, 12.7, 0.42, fill_color=LIGHT_RED,
         border_color=DARK_RED, border_pt=1)
add_text(slide, "Key principle: A unit of blood not transfused is the safest unit of blood.  "
                "Transfusion is associated with immunosuppression, increased morbidity & reduced survival in some groups (trauma, malignancy)",
         0.45, 6.07, 12.3, 0.4, font_size=12, italic=True, color=DARK_RED)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 9  ─  Blood Transfusion Procedure & Precautions
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Blood Transfusion Procedure & Precautions")

# Left: Pre-transfusion checks
add_info_box(slide, "Pre-Transfusion Checks (MANDATORY)",
    ["Confirm patient identity (2 identifiers: name + DOB + hospital no.)",
     "Check blood product label matches request form & patient ID",
     "Verify: blood group, unit number, expiry date",
     "Inspect bag: any discolouration, clots or leaks?",
     "Ensure informed consent documented",
     "Baseline observations: temp, BP, HR, RR, SpO₂"],
    0.3, 0.95, 6.1, 3.2, header_color=DARK_RED, body_color=LIGHT_RED)

# Right: Administration protocol
add_info_box(slide, "Administration Protocol",
    ["Use a sterile blood giving set with 170–200 μm filter",
     "Do NOT add drugs to blood bag",
     "Large bore IV cannula (≥18G) preferred",
     "Warm blood if large volumes or hypothermia risk (use blood warmer)",
     "Each unit: run over 90–120 min (max 4 h from removal from fridge)",
     "Discard if not used within 4 hours of removing from cold storage"],
    6.5, 0.95, 6.5, 3.2)

# Monitoring during transfusion
add_rect(slide, 0.3, 4.25, 12.7, 0.42, fill_color=TEAL)
add_text(slide, "Monitoring During Transfusion", 0.4, 4.25, 12.5, 0.42,
         font_size=15, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

monitoring_data = [
    "0 min: Start infusion – observe patient for first 5–10 min",
    "15 min: Repeat observations (temp, BP, HR, SpO₂)",
    "60 min: Mid-transfusion observations",
    "End: Final observations at completion",
    "Any adverse sign → STOP transfusion immediately, check identity, call medical team",
]
add_multi_para(slide, monitoring_data, 0.4, 4.75, 12.3, 1.8,
               font_size=14, color=DARK_GRAY)

add_rect(slide, 0.3, 6.62, 12.7, 0.42, fill_color=LIGHT_RED,
         border_color=DARK_RED, border_pt=1)
add_text(slide, "⚠  MOST transfusion errors are due to WRONG BLOOD IN TUBE (WBIT) or patient misidentification. "
                "CHECK IDENTITY AT EVERY STEP.",
         0.45, 6.63, 12.3, 0.4, font_size=13, bold=True, color=DARK_RED)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 10  ─  Complications Overview Diagram
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Complications of Blood Transfusion – Overview")

# Central box
add_rect(slide, 5.1, 3.1, 3.1, 0.9, fill_color=DARK_RED,
         border_color=WHITE, border_pt=1)
add_text(slide, "BLOOD\nTRANSFUSION\nCOMPLICATIONS", 5.1, 3.1, 3.1, 0.9,
         font_size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
         v_anchor=MSO_ANCHOR.MIDDLE)

# Surrounding boxes
comp_boxes = [
    ("Immunological\nReactions", 0.3, 1.2, MED_RED,
     ["• Acute haemolytic (ABO incompatibility)",
      "• Febrile non-haemolytic (FNHTR)",
      "• Allergic / Urticarial",
      "• Anaphylaxis",
      "• TRALI"]),
    ("Infectious\nComplications", 0.3, 4.3, TEAL,
     ["• Bacterial contamination (storage fault)",
      "• Hepatitis B / C",
      "• HIV-1, HIV-2",
      "• Malaria, CMV, EBV",
      "• vCJD (theoretical risk)"]),
    ("Massive Transfusion\nComplications", 9.7, 1.2, RGBColor(0x5A,0x22,0x8A),
     ["• Dilutional coagulopathy",
      "• Hypocalcaemia (citrate toxicity)",
      "• Hyperkalaemia (stored blood)",
      "• Hypothermia",
      "• Metabolic acidosis"]),
    ("Technical &\nMiscellaneous", 9.7, 4.3, RGBColor(0x1A,0x6E,0x3A),
     ["• Air embolism",
      "• Thrombophlebitis",
      "• Circulatory overload (TACO)",
      "• Iron overload (repeated transfusion)",
      "• Haemosiderosis (thalassaemia)"]),
]

for (label, bx, by, col, desc_list) in comp_boxes:
    add_rect(slide, bx, by, 3.2, 0.55, fill_color=col)
    add_text(slide, label, bx+0.08, by, 3.1, 0.55,
             font_size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, bx, by+0.55, 3.2, 2.0, fill_color=WHITE,
             border_color=col, border_pt=0.5)
    add_multi_para(slide, desc_list, bx+0.1, by+0.6, 3.0, 1.9,
                   font_size=12, bullet_char="")

# arrows toward centre
arrows = [
    (3.5, 1.85, "→"),
    (3.5, 4.75, "→"),
    (9.25, 1.85, "←"),
    (9.25, 4.75, "←"),
]
for (ax, ay, ar) in arrows:
    add_text(slide, ar, ax, ay, 0.5, 0.4,
             font_size=20, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 11  ─  Acute Haemolytic Transfusion Reaction
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Acute Haemolytic Transfusion Reaction (AHTR)")

add_rect(slide, 0.3, 0.88, 12.7, 0.42, fill_color=MED_RED)
add_text(slide, "Most serious transfusion complication | Usually due to ABO incompatibility | Often caused by clerical/identification error",
         0.4, 0.88, 12.5, 0.42, font_size=13, italic=True, color=WHITE,
         v_anchor=MSO_ANCHOR.MIDDLE)

# Mechanism
add_info_box(slide, "Mechanism",
    ["Recipient pre-formed antibodies (IgM anti-A or anti-B) react with donor RBC antigens",
     "Complement activation → intravascular haemolysis",
     "Cytokine release → fever, hypotension, shock",
     "Haemoglobinuria → acute tubular necrosis → renal failure",
     "DIC may develop in severe cases"],
    0.3, 1.4, 6.1, 2.5)

# Clinical features
add_info_box(slide, "Clinical Features (may start within minutes)",
    ["Anxiety, agitation, restlessness",
     "Fever with rigors",
     "Hypotension, tachycardia",
     "Loin/back pain (flank pain)",
     "Chest pain, dyspnoea",
     "Haemoglobinuria (dark red/brown urine)",
     "In anaesthetised patients: unexplained bleeding, hypotension"],
    6.5, 1.4, 6.5, 2.5)

# Management
add_rect(slide, 0.3, 4.0, 12.7, 0.38, fill_color=DARK_RED)
add_text(slide, "Management of AHTR", 0.4, 4.0, 12.5, 0.38,
         font_size=15, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

mgmt = [
    ("STOP transfusion immediately", "Disconnect giving set, keep IV access open"),
    ("Notify blood bank / haematology", "Send: patient sample, donor bag & giving set to lab"),
    ("Resuscitate", "IV fluids (0.9% saline) to maintain BP & urinary output > 0.5 mL/kg/h"),
    ("Monitor", "Urinary catheter, hourly urine output, U&Es, FBC, coagulation screen, LFT"),
    ("Treat DIC if present", "FFP, platelets, cryoprecipitate as indicated; haematology review"),
]
for i, (step, detail) in enumerate(mgmt):
    ry = 4.45 + i * 0.52
    add_rect(slide, 0.3, ry, 3.5, 0.47, fill_color=LIGHT_RED,
             border_color=DARK_RED, border_pt=0.5)
    add_text(slide, step, 0.38, ry+0.03, 3.35, 0.41,
             font_size=12, bold=True, color=DARK_RED, v_anchor=MSO_ANCHOR.MIDDLE)
    add_text(slide, detail, 3.9, ry+0.03, 9.1, 0.41,
             font_size=12, color=DARK_GRAY, v_anchor=MSO_ANCHOR.MIDDLE)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 12  ─  Other Acute Reactions
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Other Acute Transfusion Reactions")

reactions = [
    ("Febrile Non-Haemolytic\nTransfusion Reaction\n(FNHTR)",
     "Cytokine release from leukocytes in stored blood\nMost common transfusion reaction",
     "Fever (≥1°C rise), chills, rigors\nNo haemolysis",
     "Slow/stop transfusion, paracetamol\nLeukodepletion prevents most cases",
     MED_RED),
    ("Allergic Reaction\n(Urticarial)",
     "IgE-mediated reaction to plasma proteins in donor blood",
     "Urticaria, pruritus, flushing\nMild anaphylaxis (wheeze, angioedema)",
     "Stop transfusion (temp), antihistamine IV\nRestart if symptoms resolve",
     TEAL),
    ("Anaphylaxis",
     "Usually in IgA-deficient patients with anti-IgA antibodies",
     "Bronchospasm, hypotension, angioedema\nCardiovascular collapse",
     "STOP transfusion, adrenaline 0.5 mg IM\nAirway management, IV fluids, steroids",
     DARK_RED),
    ("TRALI\n(Transfusion-Related\nAcute Lung Injury)",
     "Donor antibodies activate recipient neutrophils in pulmonary vasculature\nMost often from FFP or platelets",
     "Acute hypoxia within 6h\nBilateral pulmonary infiltrates, no LV failure\nRespiratory failure",
     "Supportive: O₂, ventilatory support\nDiuretics NOT indicated\nReport to haematology & blood bank",
     RGBColor(0x5A,0x22,0x8A)),
    ("TACO\n(Transfusion-Associated\nCirculatory Overload)",
     "Excess volume causing cardiac failure\nElderly, pre-existing LV dysfunction",
     "Dyspnoea, hypertension, tachycardia\nPulmonary oedema within 12h\nRaised JVP, bilateral crackles",
     "Slow infusion rate, sit patient upright\nFurosemide IV, O₂ therapy\nPrevention: slow transfusion ≤1 unit/4h",
     RGBColor(0x1A,0x6E,0x3A)),
]

card_w = 2.52
for i, (name, cause, features, mgmt, col) in enumerate(reactions):
    bx = 0.2 + i * 2.59
    add_rect(slide, bx, 0.9, card_w, 0.85, fill_color=col)
    add_text(slide, name, bx+0.07, 0.9, card_w-0.1, 0.85,
             font_size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)
    for ji, (sub_label, sub_text, sub_color) in enumerate([
            ("Cause", cause, RGBColor(0xFF,0xF0,0xF0)),
            ("Features", features, LIGHT_TEAL),
            ("Management", mgmt, LIGHT_GRAY)]):
        sy = 1.75 + ji * 1.65
        add_rect(slide, bx, sy, card_w, 0.3, fill_color=col)
        add_text(slide, sub_label, bx+0.05, sy, card_w-0.1, 0.3,
                 font_size=11, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
        add_rect(slide, bx, sy+0.3, card_w, 1.32, fill_color=sub_color,
                 border_color=col, border_pt=0.3)
        add_text(slide, sub_text, bx+0.07, sy+0.33, card_w-0.12, 1.27,
                 font_size=11, color=DARK_GRAY, wrap=True)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 13  ─  Massive Transfusion & Complications
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Massive Transfusion – Definition & Complications")

add_rect(slide, 0.3, 0.9, 12.7, 0.42, fill_color=TEAL)
add_text(slide, "Massive Transfusion = ≥10 units pRBC in 24h  |  OR replacement of entire blood volume  |  OR >4 units in 1h with ongoing bleeding",
         0.4, 0.9, 12.5, 0.42, font_size=13, bold=True, color=WHITE,
         v_anchor=MSO_ANCHOR.MIDDLE)

comp_left = [
    ("Dilutional Coagulopathy",
     ["RBC transfusion without FFP/platelets dilutes clotting factors",
      "Use 1:1:1 ratio: pRBC:FFP:Platelets (damage control resuscitation)",
      "Give tranexamic acid (TXA) EARLY (within 3h)",
      "Monitor: PT, APTT, fibrinogen, TEG/ROTEM"]),
    ("Hypocalcaemia",
     ["Citrate preservative chelates calcium",
      "Causes: prolonged QT, tetany, cardiac depression",
      "Treatment: IV calcium gluconate (10%) or calcium chloride",
      "Monitor ionised calcium during massive transfusion"]),
    ("Hyperkalaemia",
     ["Stored RBCs leak K⁺ over time (stored blood K⁺ up to 30 mmol/L)",
      "Causes: arrhythmias, cardiac arrest",
      "Monitor ECG and electrolytes during massive transfusion",
      "Use freshest available blood in at-risk patients"]),
]
comp_right = [
    ("Hypothermia",
     ["Cold stored blood (2–6 °C) drops core temperature",
      "Hypothermia impairs coagulation, causes arrhythmias",
      "Prevention: use blood warmer for all rapid transfusions",
      "Target: maintain core temp > 36 °C"]),
    ("Hypokalaemia",
     ["May occur as cells take up K⁺ post-transfusion",
      "Particularly relevant in neonates and infants",
      "Monitor K⁺ at intervals during and after massive transfusion"]),
    ("Iron Overload\n(Chronic/Repeated Transfusion)",
     ["Each unit pRBC ≈ 250 mg elemental iron",
      "Chronic: thalassaemia, sickle cell, myelodysplasia",
      "Leads to haemosiderosis: liver, heart, endocrine",
      "Treatment: chelation therapy (desferrioxamine, deferasirox)"]),
]

for i, (title, bullets) in enumerate(comp_left):
    by = 1.45 + i * 1.88
    add_rect(slide, 0.3, by, 6.2, 0.42, fill_color=DARK_RED)
    add_text(slide, title, 0.38, by, 6.1, 0.42,
             font_size=13, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, 0.3, by+0.42, 6.2, 1.43, fill_color=WHITE,
             border_color=DARK_RED, border_pt=0.5)
    add_multi_para(slide, bullets, 0.4, by+0.47, 6.0, 1.35,
                   font_size=12, color=DARK_GRAY)

for i, (title, bullets) in enumerate(comp_right):
    by = 1.45 + i * 1.88
    add_rect(slide, 6.8, by, 6.2, 0.42, fill_color=TEAL)
    add_text(slide, title, 6.88, by, 6.1, 0.42,
             font_size=13, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, 6.8, by+0.42, 6.2, 1.43, fill_color=WHITE,
             border_color=TEAL, border_pt=0.5)
    add_multi_para(slide, bullets, 6.9, by+0.47, 6.0, 1.35,
                   font_size=12, color=DARK_GRAY)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 14  ─  Management of Coagulopathy (Damage Control Resuscitation)
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Management of Coagulopathy & Damage Control Resuscitation")

add_rect(slide, 0.3, 0.88, 12.7, 0.38, fill_color=MED_RED)
add_text(slide, "Prevention of dilutional coagulopathy is central to Damage Control Resuscitation  — Bailey & Love 28th Ed",
         0.4, 0.88, 12.5, 0.38, font_size=13, italic=True, color=WHITE,
         v_anchor=MSO_ANCHOR.MIDDLE)

# 1:1:1 ratio visual
add_rect(slide, 0.3, 1.35, 12.7, 0.4, fill_color=DARK_RED)
add_text(slide, "The 1:1:1 Balanced Transfusion Protocol (approximates whole blood)", 0.4, 1.35, 12.5, 0.4,
         font_size=15, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

ratio_items = [
    ("pRBC", "Packed Red Blood Cells\nOxygen carrying capacity\nReplaces lost RBCs", MED_RED),
    (":", "For every unit of\neach component", DARK_GRAY),
    ("FFP", "Fresh Frozen Plasma\nAll coagulation factors\nPrevents dilutional coagulopathy", TEAL),
    (":", "Give in matched\n1:1:1 ratio", DARK_GRAY),
    ("PLT", "Platelet Concentrate\nHaemostatic plug\nPrevents platelet dilution", RGBColor(0x1A,0x6E,0x3A)),
]

for i, (label, desc, col) in enumerate(ratio_items):
    bx = 1.0 + i * 2.3
    if label == ":":
        add_text(slide, ":", bx+0.5, 1.85, 0.5, 1.2,
                 font_size=48, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)
        add_text(slide, desc, bx+0.2, 3.1, 1.2, 0.6,
                 font_size=11, italic=True, color=MID_GRAY, align=PP_ALIGN.CENTER)
    else:
        add_rect(slide, bx, 1.85, 1.9, 1.2, fill_color=col,
                 border_color=WHITE, border_pt=1)
        add_text(slide, label, bx+0.05, 1.85, 1.8, 0.6,
                 font_size=28, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
        add_text(slide, desc, bx+0.05, 2.45, 1.8, 0.6,
                 font_size=11, color=WHITE, align=PP_ALIGN.CENTER)

# Additional interventions
add_rect(slide, 0.3, 3.85, 12.7, 0.42, fill_color=TEAL)
add_text(slide, "Additional Haemostatic Interventions", 0.4, 3.85, 12.5, 0.42,
         font_size=15, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

haemo_items = [
    ("Tranexamic Acid\n(TXA)", "Antifibrinolytic\nGive ASAP (within 3h of injury)\n1g IV loading, 1g over 8h", DARK_RED),
    ("Cryoprecipitate", "Rich in fibrinogen, Factor VIII, vWF\nFor fibrinogen < 1.5 g/L\n2 pools (10 units) typical dose", TEAL),
    ("Fibrinogen\nConcentrate", "Purified fibrinogen\nAlternative to cryoprecipitate\nTarget fibrinogen > 2 g/L", MED_RED),
    ("Prothrombin\nComplex Conc.", "For warfarin reversal\nContains factors II, VII, IX, X\nActed in 10–15 min", RGBColor(0x5A,0x22,0x8A)),
    ("Factor VIIa\n(rFVIIa)", "Recombinant activated factor VII\nSalvage therapy for refractory bleeding\nHigh cost, thrombotic risk", RGBColor(0x1A,0x6E,0x3A)),
]
for i, (label, desc, col) in enumerate(haemo_items):
    bx = 0.35 + i * 2.55
    add_rect(slide, bx, 4.35, 2.35, 0.42, fill_color=col)
    add_text(slide, label, bx+0.05, 4.35, 2.25, 0.42,
             font_size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, bx, 4.77, 2.35, 1.55, fill_color=WHITE,
             border_color=col, border_pt=0.5)
    add_text(slide, desc, bx+0.08, 4.82, 2.2, 1.45,
             font_size=12, color=DARK_GRAY, wrap=True)

add_rect(slide, 0.3, 6.42, 12.7, 0.38, fill_color=LIGHT_RED,
         border_color=DARK_RED, border_pt=1)
add_text(slide, "Avoid crystalloids/colloids in massive haemorrhage  |  Hypothermia + Acidosis + Coagulopathy = LETHAL TRIAD – prevent aggressively",
         0.45, 6.43, 12.3, 0.37, font_size=12, bold=True, color=DARK_RED)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 15  ─  Infectious Complications
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Infectious Complications of Blood Transfusion")

add_rect(slide, 0.3, 0.88, 12.7, 0.38, fill_color=TEAL)
add_text(slide, "Screening has dramatically reduced risk — but residual risk remains for all pathogens",
         0.4, 0.88, 12.5, 0.38, font_size=13, italic=True, color=WHITE,
         v_anchor=MSO_ANCHOR.MIDDLE)

inf_headers = ["Pathogen", "Route", "Residual Risk (per unit)", "Prevention"]
inf_rows = [
    ["HIV-1 / HIV-2", "Blood/plasma", "~1 in 4–5 million", "NAT testing, donor exclusion"],
    ["Hepatitis C (HCV)", "Blood/plasma", "~1 in 1–2 million", "Anti-HCV + NAT testing"],
    ["Hepatitis B (HBV)", "Blood", "~1 in 500,000", "HBsAg + anti-HBc + NAT testing"],
    ["Bacterial contamination", "Platelets (stored 22°C)", "~1 in 5,000 units", "Bacterial culture of platelet units"],
    ["Malaria", "RBCs", "Very rare in UK (donor travel screening)", "Donor deferral, geographic screening"],
    ["CMV / EBV", "Leukocytes", "Common — usually subclinical", "CMV-negative or leukodepleted blood for at-risk"],
    ["vCJD / prions", "Blood/plasma", "Theoretical risk", "Universal leukodepletion (UK since 1999)"],
]

draw_table(slide, inf_headers, inf_rows, 0.3, 1.35,
           [2.0, 2.0, 2.8, 5.5], row_height=0.45)

add_rect(slide, 0.3, 6.6, 12.7, 0.42, fill_color=LIGHT_RED,
         border_color=DARK_RED, border_pt=1)
add_text(slide, "UK Blood Safety: Donations tested for HBV, HCV, HIV-1/2, HTLV, Syphilis, and leukodepleted since 1999.  "
                "Bacterial contamination of platelets remains the highest infectious risk today.",
         0.45, 6.61, 12.3, 0.42, font_size=12, italic=True, color=DARK_RED)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 16  ─  Prevention of Transfusion Complications
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Prevention of Transfusion Complications")

prev_sections = [
    ("Administrative & Identification Safeguards",
     ["Positive patient ID at every step: sampling, collection, bedside check",
      "WBIT (Wrong Blood In Tube) prevention: one patient at a time",
      "Electronic blood tracking systems",
      "Informed consent documentation",
      "Trained staff: only trained personnel to administer blood"],
     0.3, 1.0, 6.1, 2.7, DARK_RED),
    ("Blood Product Safeguards",
     ["Pre-donation screening of all donors",
      "Mandatory serological and NAT testing of every unit",
      "Universal leukodepletion (UK)",
      "Strict cold chain maintenance (2–6 °C for RBCs)",
      "Short storage time for platelets (5–7 days)",
      "Single-donor apheresis preferred over pooled platelets"],
     6.5, 1.0, 6.5, 2.7, TEAL),
    ("Clinical Best Practices",
     ["Adopt restrictive transfusion strategy (trigger Hb < 7–8 g/dL)",
      "Patient Blood Management programme",
      "Autologous options: cell salvage, pre-donation",
      "Routine antifibrinolytics in high-risk surgical cases",
      "Pre-op iron/EPO optimisation",
      "Avoid unnecessary or prophylactic transfusions"],
     0.3, 3.85, 6.1, 2.7, MED_RED),
    ("Special Population Precautions",
     ["Neonates & immunocompromised: use irradiated blood",
      "CMV-seronegative: use CMV-negative or leukodepleted units",
      "Thalassaemia / sickle cell: extended antigen matching",
      "Elderly: slow rate (≤1 unit/4h), furosemide cover if TACO risk",
      "Renal failure: avoid hyperkalaemia (use washed RBCs)",
      "Pregnant women: Rh-matched blood essential"],
     6.5, 3.85, 6.5, 2.7, RGBColor(0x1A,0x6E,0x3A)),
]

for (title, bullets, bx, by, bw, bh, col) in prev_sections:
    add_rect(slide, bx, by, bw, 0.42, fill_color=col)
    add_text(slide, title, bx+0.1, by, bw-0.15, 0.42,
             font_size=13, bold=True, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, bx, by+0.42, bw, bh-0.42, fill_color=WHITE,
             border_color=col, border_pt=0.5)
    add_multi_para(slide, bullets, bx+0.12, by+0.48, bw-0.22, bh-0.55,
                   font_size=12.5, color=DARK_GRAY)

add_rect(slide, 0.3, 6.65, 12.7, 0.42, fill_color=LIGHT_RED,
         border_color=DARK_RED, border_pt=1)
add_text(slide, "\"The safest transfusion is one that is not given\" — Patient Blood Management principle",
         0.45, 6.66, 12.3, 0.42, font_size=13, bold=True, italic=True, color=DARK_RED,
         align=PP_ALIGN.CENTER)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 17  ─  Autologous Blood Transfusion
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Autologous Blood Transfusion")

add_rect(slide, 0.3, 0.88, 12.7, 0.38, fill_color=TEAL)
add_text(slide, "Transfusion of a patient's own blood — eliminates alloimmune reactions and reduces infectious risk",
         0.4, 0.88, 12.5, 0.38, font_size=13, italic=True, color=WHITE,
         v_anchor=MSO_ANCHOR.MIDDLE)

auto_methods = [
    ("Pre-operative\nAutologous Donation\n(PAD)",
     ["Patient donates own blood 2–4 weeks before elective surgery",
      "Up to 3 units collected (must be Hb > 11 g/dL)",
      "Blood stored, returned during/after surgery",
      "Limitations: anaemia pre-op, logistics, waste if unused",
      "Suitable for: elective orthopaedic, cardiac, vascular surgery"],
     DARK_RED),
    ("Intraoperative\nCell Salvage (ICS)",
     ["Blood aspirated from surgical field during operation",
      "Washed, filtered and re-infused via cell saver",
      "Reduces allogeneic transfusion by 40–60%",
      "Contraindicated: bowel surgery contamination, malignancy (relative CI)",
      "Standard in cardiac, orthopaedic, vascular surgery"],
     TEAL),
    ("Postoperative\nCell Salvage",
     ["Collects wound drainage blood (e.g. after arthroplasty)",
      "Re-infused within 6h via filter",
      "Particularly useful in: total knee/hip replacement",
      "Reduces need for allogeneic transfusion"],
     MED_RED),
    ("Acute Normovolaemic\nHaemodilution (ANH)",
     ["1–3 units blood removed at start of surgery",
      "Volume replaced with colloid/crystalloid",
      "Blood returned at end of surgery or when needed",
      "Patient bleeds diluted blood intraoperatively",
      "Restores Hb at end; minimises donor exposure"],
     RGBColor(0x1A,0x6E,0x3A)),
]

card_w = 3.1
for i, (name, bullets, col) in enumerate(auto_methods):
    bx = 0.3 + i * 3.25
    add_rect(slide, bx, 1.38, card_w, 0.65, fill_color=col)
    add_text(slide, name, bx+0.08, 1.38, card_w-0.12, 0.65,
             font_size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)
    add_rect(slide, bx, 2.03, card_w, 4.48, fill_color=WHITE,
             border_color=col, border_pt=0.5)
    add_multi_para(slide, bullets, bx+0.1, 2.1, card_w-0.2, 4.35,
                   font_size=13, color=DARK_GRAY)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 18  ─  Summary Flowchart
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
light_bg(slide)
content_header(slide, "Clinical Decision Algorithm – Blood Transfusion")

# Flowchart using boxes and arrows
flow_steps = [
    (5.2, 1.0, 2.9, 0.55, "Patient requires blood transfusion?", DARK_RED, WHITE),
    (5.2, 1.8, 2.9, 0.55, "Indication confirmed?\n(Hb <7 g/dL or acute loss/symptomatic)", TEAL, WHITE),
    (5.2, 2.6, 2.9, 0.55, "Autologous option available?\n(Cell salvage / PAD)", MED_RED, WHITE),
    (1.5, 3.5, 2.9, 0.55, "Use autologous blood\n(ICS / PAD / ANH)", RGBColor(0x1A,0x6E,0x3A), WHITE),
    (8.0, 3.5, 2.9, 0.55, "Request allogeneic blood\nSend group & X-match", DARK_RED, WHITE),
    (5.2, 4.4, 2.9, 0.55, "Pre-transfusion identity\nchecks COMPLETED?", TEAL, WHITE),
    (5.2, 5.2, 2.9, 0.55, "Administer blood with\nmonitoring & observations", RGBColor(0x1A,0x6E,0x3A), WHITE),
    (5.2, 6.05, 2.9, 0.55, "Adverse reaction?\nSTOP + manage per protocol", MED_RED, WHITE),
]

for (bx, by, bw, bh, label, bg_col, txt_col) in flow_steps:
    add_rect(slide, bx, by, bw, bh, fill_color=bg_col,
             border_color=WHITE, border_pt=1)
    add_text(slide, label, bx+0.08, by+0.03, bw-0.12, bh-0.06,
             font_size=12, bold=True, color=txt_col, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)

# Arrow connectors (simplified)
arrow_pairs = [
    (6.65, 1.57, 6.65, 1.8),    # 1→2
    (6.65, 2.37, 6.65, 2.6),    # 2→3
    (5.2, 2.87, 2.9, 3.5),      # 3→Yes (auto)
    (8.1, 2.87, 9.45, 3.5),     # 3→No (allogeneic)
    (4.4, 3.78, 6.7, 4.4),      # auto→check
    (9.45, 3.78, 7.55, 4.4),    # allogenic→check
    (6.65, 4.97, 6.65, 5.2),    # 5→6
    (6.65, 5.77, 6.65, 6.05),   # 6→7
]
for (x1, y1, x2, y2) in arrow_pairs:
    # draw simple line
    tb = slide.shapes.add_textbox(Inches(x1), Inches(y1), Inches(0.01), Inches(y2-y1+0.01))
    # Just add an arrow symbol
    pass  # skip actual line drawing; use text arrows instead

# YES / NO labels
add_text(slide, "YES", 2.7, 3.25, 0.8, 0.25, font_size=11, bold=True, color=RGBColor(0x1A,0x6E,0x3A))
add_text(slide, "NO", 9.0, 3.25, 0.8, 0.25, font_size=11, bold=True, color=DARK_RED)
add_text(slide, "↓", 6.55, 1.55, 0.5, 0.28, font_size=18, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)
add_text(slide, "↓", 6.55, 2.35, 0.5, 0.28, font_size=18, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)
add_text(slide, "↙", 5.8, 3.1, 0.7, 0.4, font_size=22, bold=True, color=RGBColor(0x1A,0x6E,0x3A), align=PP_ALIGN.CENTER)
add_text(slide, "↘", 7.2, 3.1, 0.7, 0.4, font_size=22, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)
add_text(slide, "↓", 6.55, 4.95, 0.5, 0.28, font_size=18, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)
add_text(slide, "↓", 6.55, 5.75, 0.5, 0.28, font_size=18, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SLIDE 19  ─  Key Points / Summary
# ══════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, fill_color=DARK_RED)
add_rect(slide, 0, 5.7, 13.333, 0.07, fill_color=WHITE)
add_rect(slide, 0, 5.79, 13.333, 0.07, fill_color=GOLD)

add_text(slide, "KEY TAKE-HOME POINTS", 0.5, 0.2, 12.3, 0.85,
         font_size=34, bold=True, color=WHITE)
add_rect(slide, 0.5, 1.05, 11.8, 0.06, fill_color=GOLD)

key_points = [
    "Blood & blood products must be used judiciously – unnecessary transfusion carries immunological and infectious risks.",
    "Transfusion trigger: Hb < 7 g/dL (stable patients); higher threshold for patients with cardiovascular disease or active bleeding.",
    "ABO incompatibility is most often caused by patient misidentification errors – strict identity checks are mandatory at every step.",
    "Massive transfusion: use 1:1:1 (pRBC:FFP:Platelets) + early tranexamic acid + prevent lethal triad (hypothermia, acidosis, coagulopathy).",
    "STOP transfusion immediately at first sign of any adverse reaction; keep IV access, send samples, call medical team.",
    "Patient Blood Management (PBM) is the gold standard: optimise haemopoiesis → minimise blood loss → optimise anaemia tolerance.",
    "Autologous blood (cell salvage, PAD, ANH) is the safest option when available – eliminates alloimmune & infectious risk.",
    "Special populations: irradiated blood for neonates/immunocompromised; Rh-negative blood for women of childbearing age; CMV-negative for at-risk patients.",
]

for i, pt in enumerate(key_points):
    add_rect(slide, 0.5, 1.2 + i * 0.72, 0.45, 0.45,
             fill_color=GOLD, border_color=WHITE, border_pt=0.5)
    add_text(slide, str(i+1), 0.5, 1.22 + i * 0.72, 0.45, 0.43,
             font_size=14, bold=True, color=DARK_RED, align=PP_ALIGN.CENTER,
             v_anchor=MSO_ANCHOR.MIDDLE)
    add_text(slide, pt, 1.05, 1.2 + i * 0.72, 11.7, 0.68,
             font_size=14, color=WHITE, wrap=True)

add_text(slide, "Reference: Bailey & Love's Short Practice of Surgery, 28th Ed  |  Pye's Surgical Handicraft, 22nd Ed",
         0.5, 6.0, 12.3, 0.45, font_size=11, color=LIGHT_RED, italic=True)

footer(slide)

# ══════════════════════════════════════════════════════════════════════════════
# SAVE
# ══════════════════════════════════════════════════════════════════════════════
out_path = "/tmp/workspace/blood-transfusion-ppt/Blood_Transfusion_Surgery.pptx"
prs.save(out_path)
print(f"Saved: {out_path}")
print(f"Total slides: {len(prs.slides)}")