Make one page notes of these with all of them covered ...try flowchart or anything for maximum efficiency...I want to use for last minute revision make sure to cover everything...don't write too small...as I need to print it out and everything single things in the next way written in one page note and another page add osce pearls or case questions in a way these notes can be implemented or how an AMC exam wud ask these notes
cd /home/daytona/workspace/attachments/da1db803-171c-4557-b9ed-a9e2e9c93ab0/ && python3 -c " from pypdf import PdfReader reader = PdfReader('Anemia.pdf') print(f'Pages: {len(reader.pages)}') text = '' for i, page in enumerate(reader.pages): text += f'\n--- PAGE {i+1} ---\n' text += page.extract_text() print(text[:8000]) "
mkdir -p /home/daytona/workspace/anemia-notes && ls /home/daytona/workspace/anemia-notes/
~/anemia-notes/build_notes.py
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.platypus import (SimpleDocTemplate, Table, TableStyle, Paragraph,
Spacer, HRFlowable)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT
from reportlab.platypus.flowables import Flowable
from reportlab.pdfgen import canvas
import math
OUTPUT = "/home/daytona/workspace/anemia-notes/Anemia_Revision_Notes.pdf"
# ── Colour palette ─────────────────────────────────────────────────────────────
C_NAVY = colors.HexColor("#1A3A5C")
C_TEAL = colors.HexColor("#0E7C7B")
C_AMBER = colors.HexColor("#F4A300")
C_RED = colors.HexColor("#C0392B")
C_PURPLE = colors.HexColor("#6C3483")
C_GREEN = colors.HexColor("#1E8449")
C_LGRAY = colors.HexColor("#F2F4F4")
C_MGRAY = colors.HexColor("#D5D8DC")
C_ORANGE = colors.HexColor("#E67E22")
C_LBLUE = colors.HexColor("#D6EAF8")
C_LGREEN = colors.HexColor("#D5F5E3")
C_LYELL = colors.HexColor("#FEF9E7")
C_LPURP = colors.HexColor("#F4ECF7")
W, H = A4 # 595 x 842
# ── Custom Flowables ───────────────────────────────────────────────────────────
class BoxArrow(Flowable):
"""A horizontal process-flow diagram: boxes connected by arrows."""
def __init__(self, steps, width, box_h=22, fsize=7.5, colors_list=None):
Flowable.__init__(self)
self.steps = steps
self.width = width
self.box_h = box_h
self.fsize = fsize
self.colors_list = colors_list or [C_NAVY]*len(steps)
n = len(steps)
arrow_w = 10
self.box_w = (width - arrow_w*(n-1)) / n
self.height = box_h
def draw(self):
c = self.canv
n = len(self.steps)
arrow_w = 10
for i, (text, col) in enumerate(zip(self.steps, self.colors_list)):
x = i*(self.box_w + arrow_w)
# box
c.setFillColor(col)
c.setStrokeColor(colors.white)
c.roundRect(x, 0, self.box_w, self.box_h, 4, fill=1, stroke=1)
# text
c.setFillColor(colors.white)
c.setFont("Helvetica-Bold", self.fsize)
lines = text.split('\n')
line_h = self.fsize + 1.5
total_h = line_h * len(lines)
start_y = (self.box_h + total_h) / 2 - self.fsize
for j, line in enumerate(lines):
c.drawCentredString(x + self.box_w/2, start_y - j*line_h, line)
# arrow
if i < n-1:
ax = x + self.box_w
ay = self.box_h/2
c.setFillColor(C_AMBER)
c.setStrokeColor(C_AMBER)
c.beginPath()
path = c.beginPath()
path.moveTo(ax+1, ay)
path.lineTo(ax+arrow_w-2, ay+4)
path.lineTo(ax+arrow_w-2, ay-4)
path.close()
c.drawPath(path, fill=1, stroke=0)
class VertFlow(Flowable):
"""Vertical flowchart: boxes with downward arrows."""
def __init__(self, steps, width, box_h=18, fsize=7.5, colors_list=None, arrows=True):
Flowable.__init__(self)
self.steps = steps
self.width = width
self.box_h = box_h
self.fsize = fsize
self.colors_list = colors_list or [C_NAVY]*len(steps)
self.arrows = arrows
arrow_h = 10
n = len(steps)
self.height = n * box_h + (n-1)*arrow_h if arrows else n*box_h
def draw(self):
c = self.canv
arrow_h = 10
n = len(self.steps)
for i, (text, col) in enumerate(zip(self.steps, self.colors_list)):
y = self.height - (i+1)*self.box_h - i*arrow_h if self.arrows else self.height - (i+1)*self.box_h
# box
c.setFillColor(col)
c.setStrokeColor(colors.white)
c.roundRect(0, y, self.width, self.box_h, 4, fill=1, stroke=1)
c.setFillColor(colors.white)
c.setFont("Helvetica-Bold", self.fsize)
c.drawCentredString(self.width/2, y + self.box_h/2 - self.fsize/2, text)
# arrow down
if self.arrows and i < n-1:
ax = self.width/2
ay = y
c.setFillColor(C_AMBER)
path = c.beginPath()
path.moveTo(ax, ay-2)
path.lineTo(ax-4, ay-arrow_h+2)
path.lineTo(ax+4, ay-arrow_h+2)
path.close()
c.drawPath(path, fill=1, stroke=0)
c.setStrokeColor(C_AMBER)
c.setLineWidth(1.5)
c.line(ax, ay-1, ax, ay-arrow_h+2)
class SectionHeader(Flowable):
def __init__(self, title, width, bg=C_NAVY, fsize=9.5):
Flowable.__init__(self)
self.title = title
self.width = width
self.bg = bg
self.fsize = fsize
self.height = fsize + 7
def draw(self):
c = self.canv
c.setFillColor(self.bg)
c.roundRect(0, 0, self.width, self.height, 3, fill=1, stroke=0)
c.setFillColor(colors.white)
c.setFont("Helvetica-Bold", self.fsize)
c.drawString(6, 4, self.title)
# ── Styles ─────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()
def ps(name, parent='Normal', **kw):
return ParagraphStyle(name, parent=styles[parent], **kw)
body = ps('body', fontSize=7.5, leading=10, spaceAfter=1)
bold7 = ps('bold7', fontSize=7.5, leading=10, fontName='Helvetica-Bold')
tiny = ps('tiny', fontSize=6.8, leading=9)
bullet = ps('bullet', fontSize=7.2, leading=9.5, leftIndent=8, bulletIndent=0, spaceAfter=1)
head2 = ps('head2', fontSize=8.5, leading=11, fontName='Helvetica-Bold', textColor=C_NAVY)
head3 = ps('head3', fontSize=7.8, leading=10, fontName='Helvetica-Bold', textColor=C_TEAL)
center = ps('center', fontSize=7.5, leading=10, alignment=TA_CENTER)
small_b= ps('smallb', fontSize=6.8, leading=9, fontName='Helvetica-Bold')
def b(t): return f"<b>{t}</b>"
def col(t, c): return f'<font color="{c}">{t}</font>'
# ── Table helper ───────────────────────────────────────────────────────────────
def styled_table(data, col_widths, header_bg=C_NAVY, row_colors=None, fsize=6.8):
"""Build a compact styled table."""
ts = [
('BACKGROUND', (0,0), (-1,0), header_bg),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,-1), fsize),
('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.white, C_LGRAY]),
('GRID', (0,0), (-1,-1), 0.4, C_MGRAY),
('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
('TOPPADDING', (0,0), (-1,-1), 2),
('BOTTOMPADDING',(0,0),(-1,-1), 2),
('LEFTPADDING', (0,0), (-1,-1), 3),
('RIGHTPADDING',(0,0), (-1,-1), 3),
]
if row_colors:
for (r, c_col) in row_colors:
ts.append(('BACKGROUND', (0,r), (-1,r), c_col))
t = Table(data, colWidths=col_widths)
t.setStyle(TableStyle(ts))
return t
# ══════════════════════════════════════════════════════════════════════════════
# PAGE 1 – MASTER REVISION NOTES
# ══════════════════════════════════════════════════════════════════════════════
def build_page1(elements, PW):
SP = lambda n: Spacer(1, n*mm)
# ── TITLE BANNER ─────────────────────────────────────────────────────────
title_data = [[Paragraph('<font color="white"><b>🩸 APPROACH TO ANAEMIA — PART 1 | LAST-MINUTE REVISION</b></font>',
ps('tt', fontSize=11, leading=13, alignment=TA_CENTER))]]
t = Table(title_data, colWidths=[PW])
t.setStyle(TableStyle([
('BACKGROUND', (0,0),(-1,-1), C_NAVY),
('TOPPADDING', (0,0),(-1,-1), 5),
('BOTTOMPADDING', (0,0),(-1,-1), 5),
]))
elements.append(t)
elements.append(SP(1.5))
# ── Two-column layout via a master table ─────────────────────────────────
LEFT = []
RIGHT = []
S = lambda n: Spacer(1, n*mm)
# ═══════ LEFT COLUMN ═══════════════════════════════════════════════════
# 1. ANAEMIA DEFINITION + RI CALCULATION FLOW
LEFT.append(SectionHeader("1. DEFINE ANAEMIA & RETICULOCYTE INDEX (RI)", PW*0.49, C_NAVY))
LEFT.append(S(1))
ri_steps = [
"Get Retic count\n(from lab %)",
"Absolute Retic\n= Retic% × Pt Hct\n÷ Normal Hct",
"RI = Abs Retic\n÷ Maturation\nFactor (MF)",
"RI < 2\nHypoproliferative\n(BM failure/deficit)",
"RI ≥ 2\nHyperproliferative\n(Haemolysis/\nBlood loss)"
]
ri_colors = [C_TEAL, C_TEAL, C_NAVY, C_RED, C_GREEN]
LEFT.append(BoxArrow(ri_steps, PW*0.49, box_h=30, fsize=6.5, colors_list=ri_colors))
LEFT.append(S(1))
mf_data = [
[b("Pt Hct"), b("MF")],
["> 35%", "1.0"],
["25–35%", "1.5"],
["20–25%", "2.0"],
["< 20%", "2.5"],
]
LEFT.append(styled_table(mf_data, [PW*0.22, PW*0.27], C_TEAL, fsize=7))
LEFT.append(S(2))
# 2. CLASSIFICATION FLOWCHART
LEFT.append(SectionHeader("2. CLASSIFICATION FLOWCHART", PW*0.49, C_PURPLE))
LEFT.append(S(1))
class_data = [
[b("MCV"), b("Type"), b("Key causes")],
[col("↓ MCV\n< 80", "#C0392B"), "Microcytic",
"IDA · Thalassaemia · SA · AoCD (late)"],
[col("Normal\n80–100", "#1A3A5C"), "Normocytic",
"Acute blood loss · Haemolysis\nAoCD (early) · CKD · BM failure"],
[col("↑ MCV\n> 100", "#1E8449"), "Macrocytic",
"B12/Folate def · Drugs*\nLiver dis. · Hypothyroid"],
]
LEFT.append(styled_table(class_data, [PW*0.09, PW*0.12, PW*0.28],
C_PURPLE, fsize=6.8))
LEFT.append(S(0.5))
LEFT.append(Paragraph(b("*Drugs → Megaloblastic: ")+"Anti-cancer, Folate antagonists, Biguanides (Metformin), Anti-epileptics, ART, Nitrous Oxide", tiny))
LEFT.append(S(2))
# 3. MICROCYTIC DETAIL
LEFT.append(SectionHeader("3. MICROCYTIC — KEY DEFECT LADDER", PW*0.49, C_RED))
LEFT.append(S(1))
mic_steps = ["Globin defect\n→ THALASSAEMIA", "Heme/Fe defect\n→ IDA", "Heme/Fe defect\n→ SA", "Fe trapped in RE\n→ AoCD"]
mic_cols = [C_PURPLE, C_RED, C_ORANGE, C_TEAL]
LEFT.append(BoxArrow(mic_steps, PW*0.49, box_h=22, fsize=6.8, colors_list=mic_cols))
LEFT.append(S(2))
# 4. HAEMOLYSIS BRANCH
LEFT.append(SectionHeader("4. HAEMOLYSIS — EV vs IV", PW*0.49, C_ORANGE))
LEFT.append(S(1))
hemo_data = [
[b("Feature"), b("Extravascular (EV)"), b("Intravascular (IV)")],
["Site", "Spleen/liver macrophages", "Inside blood vessels"],
["Spherocytes", "MORE common", "Less common"],
["Splenomegaly", "YES", "Less"],
["Haptoglobin", "↓", "↓↓↓"],
["Haemosiderinuria", "No", "Yes (chronic)"],
["Bilirubin/Gallstones", "YES", "Less"],
["COHb", "↑ CoHb", "—"],
["LDH", "Elevated", "Elevated++"],
]
LEFT.append(styled_table(hemo_data, [PW*0.12, PW*0.185, PW*0.185],
C_ORANGE, fsize=6.5))
LEFT.append(S(1))
LEFT.append(Paragraph(b("Leukoerythroblastic picture: ")+"Dacrocytes · Nucleated RBC · Immature WBC · Hepatosplenomegaly · Hyperseg. neutrophils (single PMN >6 lobes / >5% PMN with >5 lobes)", tiny))
LEFT.append(S(2))
# ═══════ RIGHT COLUMN ══════════════════════════════════════════════════
# 5. DIFFERENTIALS TABLE
RIGHT.append(SectionHeader("5. MICROCYTIC DIFFERENTIALS AT A GLANCE", PW*0.49, C_TEAL))
RIGHT.append(S(1))
diff_data = [
[b("Feature"), b("IDA"), b("AoCD"), b("Thal Trait"), b("SA")],
["RBC/Retic", "↓ (MI>13)", "↓", "↑ (MI<13)", "↓"],
["RDW", "↑", "Normal", "Normal", "↑"],
["Fe", "↓", "↓", "↑", "↑↑"],
["Ferritin", "↓", "↑", "Normal/↑", "↑"],
["sTfR", "↑", "Normal", "Normal", "Normal"],
["TIBC", "↑", "↓", "Normal", "Normal"],
["TSAT", "<18%", ">18%", "↑", "↑"],
["sTfR/log\nFerritin", ">2", "<1", "—", "—"],
["Hepcidin", "↓", "↑", "Normal", "—"],
["FEP", "↑", "↑", "Normal", "↑"],
["BM Fe", "Absent", "Present", "Present", "Present+RS"],
["Electro.", "Normal", "Normal", "Abnormal", "Normal"],
["Rx", "Oral/IV Fe", "Rx cause\n±Fe±ESA", "None", "Reversible\n±Pyridoxine"],
]
RIGHT.append(styled_table(diff_data,
[PW*0.075, PW*0.095, PW*0.1, PW*0.1, PW*0.1],
C_TEAL, fsize=6.5))
RIGHT.append(S(1))
RIGHT.append(Paragraph(b("IDA Rx: ")+
"Oral Fe 200mg/day. 6 wks→Hb corrects, 6 mo→stores replete. "
"Poor response if Hb <2g/dL rise in 3 wks → non-compliance, ongoing bleed, malabsorption, wrong Dx, mixed deficiency. "
"↓ absorption: Ca²⁺, PPIs/H₂RA, phytates, phosphates, tannates. "
b("IV Fe: ")+"Intolerance, malabsorption, ESA pre-Rx, CKD-HD, cancer, CHF, IRIDA.", tiny))
RIGHT.append(S(2))
# 6. THALASSAEMIA
RIGHT.append(SectionHeader("6. THALASSAEMIA", PW*0.49, C_PURPLE))
RIGHT.append(S(1))
thal_data = [
[b("Type"), b("Genotype"), b("Clinical")],
[col("α-Thal","#6C3483"), "1 deletion", "Silent carrier"],
["", "2 deletions", "Asymptomatic + mild anaemia"],
["", "3 deletions", "HbH disease"],
["", "4 deletions", "Death in utero (Hb Barts)"],
[col("β-Thal","#6C3483"), "β°β° / β+β+", "Thal MAJOR"],
["", "β°β / β+β", "Thal MINOR (Asx)"],
["", "β°β+", "Thal major/intermedia"],
["", "HbSβ° / HbEβ°", "Thal major phenotype"],
]
RIGHT.append(styled_table(thal_data, [PW*0.065, PW*0.13, PW*0.295],
C_PURPLE, fsize=6.5))
RIGHT.append(S(0.5))
RIGHT.append(Paragraph(
b("β-Thal Major features: ")+"Chipmunk facies · Crew-cut skull XR · Pathologic # · HSM (EMH) · High-output HF · Bilirubin gallstones · Fe overload<br/>"
b("Rx: ")+"Regular PRBC + Fe chelators ± splenectomy<br/>"
b("Chelators: ")+"IV Deferoxamine | Oral Deferiprone TID (best for cardiac Fe) | Oral Deferasirox OD (preferred)<br/>"
b("Screening: ")+"Nestroft test (NESTROF = naked-eye single-tube red-cell osmotic fragility test)",
tiny))
RIGHT.append(S(2))
# 7. AIHA TABLE
RIGHT.append(SectionHeader("7. AUTOIMMUNE HAEMOLYTIC ANAEMIA (AIHA)", PW*0.49, C_RED))
RIGHT.append(S(1))
aiha_data = [
[b("Feature"), b("Warm AIHA"), b("Cold Agg. Syn."), b("PCH")],
["Incidence", "70%", "10–15%", "1–2%"],
["Ab", "IgG", "IgM", "IgG (biphasic)"],
["Complement", "Not activated", "Activated", "Activated"],
["Reaction temp", "37°C", "<37°C", "Biphasic"],
["Haemolysis", "Mostly EV", "Mostly IV", "IV"],
["Smear", "Spherocytes", "Rouleaux/Agg.", "Spherocytes"],
["Clinical", "Fever, jaundice,\nsplenomegaly", "Chronic anaemia\n+ acrocyanosis", "Post-infection\nacute haemolysis"],
["Etiology", "Idiopathic, CTD,\nNeoplasm, Drugs,\nInfections", "Monoclonal/\nPolyclonal, Drugs", "Idiopathic,\nInfections"],
["Rx", "CS, IVIg,\nRituximab,\nSplenectomy", "Avoid cold\n± Rituximab\n(CS ineffective)", "Supportive,\nAvoid cold"],
]
RIGHT.append(styled_table(aiha_data,
[PW*0.085, PW*0.13, PW*0.13, PW*0.13],
C_RED, fsize=6.3))
RIGHT.append(S(0.5))
RIGHT.append(Paragraph(
b("Drug AIHA — 3 mechanisms: ")+
"1. Hapten → β-lactams (Penicillin) "
"2. Immune complex → Quinidine "
"3. Drug-independent → Methyldopa",
tiny))
# ── ASSEMBLE TWO-COLUMN TABLE ────────────────────────────────────────────
master = Table([[LEFT, RIGHT]], colWidths=[PW*0.49, PW*0.49])
master.setStyle(TableStyle([
('VALIGN', (0,0),(-1,-1), 'TOP'),
('LEFTPADDING', (0,0),(-1,-1), 0),
('RIGHTPADDING', (0,0),(-1,-1), 0),
('TOPPADDING', (0,0),(-1,-1), 0),
('BOTTOMPADDING',(0,0),(-1,-1), 0),
('INNERGRID', (0,0),(-1,-1), 0.5, C_MGRAY),
]))
elements.append(master)
# footer
elements.append(S(1))
elements.append(HRFlowable(width=PW, color=C_MGRAY))
elements.append(Paragraph(
col("Page 1 of 2 | Approach to Anaemia Part 1 | Last-Minute Revision | © 2026", "#888888"),
ps('footer', fontSize=6, leading=8, alignment=TA_CENTER)))
# ══════════════════════════════════════════════════════════════════════════════
# PAGE 2 – OSCE PEARLS + AMC-STYLE CASE Qs
# ══════════════════════════════════════════════════════════════════════════════
def build_page2(elements, PW):
from reportlab.platypus import PageBreak
elements.append(PageBreak())
SP = lambda n: Spacer(1, n*mm)
# Title
title_data = [[Paragraph(
'<font color="white"><b>🏥 OSCE PEARLS & AMC-STYLE CASE QUESTIONS — ANAEMIA PART 1</b></font>',
ps('tt2', fontSize=11, leading=13, alignment=TA_CENTER))]]
t = Table(title_data, colWidths=[PW])
t.setStyle(TableStyle([
('BACKGROUND', (0,0),(-1,-1), C_RED),
('TOPPADDING', (0,0),(-1,-1), 5),
('BOTTOMPADDING', (0,0),(-1,-1), 5),
]))
elements.append(t)
elements.append(SP(1.5))
LEFT = []
RIGHT = []
S = lambda n: Spacer(1, n*mm)
# ═══ LEFT ═══════════════════════════════════════════════════════════════
LEFT.append(SectionHeader("OSCE PEARLS — HIGH-YIELD CLINICAL TRIGGERS", PW*0.49, C_NAVY))
LEFT.append(S(1))
pearls = [
("🔴 IDA", [
"Koilonychia (spoon nails) + pallor + pica → IDA until proven otherwise",
"Check for occult GI bleed in elderly (PR blood, FOBT)",
"Always ask: menstrual history, dietary habits, NSAIDs use",
"Oral Fe → black stools (reassure patient, NOT occult +ve on FOBT)",
"If Hb rises <2g/dL in 3 wks: think non-compliance, ongoing bleed, malabsorption, mixed def",
"Best absorbed Fe salt = Ferrous fumarate (35% elemental Fe)",
"IRIDA = Iron-refractory iron deficiency anaemia (TMPRSS6 mutation)",
]),
("🟠 AoCD", [
"Ferritin is an ACUTE-PHASE REACTANT — elevated in AoCD even though Fe is low",
"sTfR/log ferritin ratio: >2 = IDA, <1 = AoCD (key distinguisher in mixed/chronic illness)",
"Hepcidin HIGH in AoCD (blocks ferroportin → Fe trapped in macrophages)",
"TSAT >18% + low serum Fe + high ferritin = AoCD",
]),
("🟡 Thalassaemia Trait", [
"Low MCV + NORMAL RDW + ↑ RBC count → suspect Thal trait (contrast: IDA has ↑ RDW)",
"Mentzer Index: RBC/MCV. MI <13 = Thal, MI >13 = IDA",
"Hb electrophoresis: ↑ HbA2 (>3.5%) in β-thal trait",
"β-thal major: transfusion-dependent from infancy; Chipmunk facies + crew-cut XR",
"Deferasirox OD = preferred chelator; Deferiprone = preferred for cardiac siderosis",
]),
("🔵 Sideroblastic Anaemia", [
"Ring sideroblasts on iron stain (Prussian blue) = pathognomonic",
"Reversible causes: alcohol, INH (give Pyridoxine B6), lead, Cu deficiency",
"X-linked: ALAS2 mutation; Acquired: MDS-RARS",
"Fe indices all elevated (Fe, Ferritin, TSAT) — confused with haemochromatosis",
]),
]
for title, pts in pearls:
LEFT.append(Paragraph(b(title), bold7))
for p in pts:
LEFT.append(Paragraph(f"• {p}", bullet))
LEFT.append(S(1))
LEFT.append(SectionHeader("HAEMOLYSIS PEARLS", PW*0.49, C_ORANGE))
LEFT.append(S(0.5))
hpearls = [
"Coombs test (DAT): Positive in AIHA (NOT in hereditary spherocytosis or G6PD)",
"G6PD deficiency: Heinz bodies + bite cells; triggered by oxidant stress (primaquine, dapsone, fava beans)",
"Warm AIHA: IgG → treat with steroids; if refractory → rituximab or splenectomy",
"Cold AIHA: IgM → steroids INEFFECTIVE; avoid cold, rituximab",
"PCH: IgG biphasic; cold exposure → haemolysis occurs at warmth rewarming",
"Drug AIHA: Penicillin=hapten; Quinidine=immune complex; Methyldopa=drug-independent autoantibody",
"Hypersegmented neutrophils (>6 lobes or >5% with >5 lobes) = B12/folate deficiency signature",
"Leukoerythroblastic picture = bone marrow infiltration (myelofibrosis, metastases)",
]
for p in hpearls:
LEFT.append(Paragraph(f"• {p}", bullet))
LEFT.append(S(1.5))
LEFT.append(SectionHeader("KEY NUMBERS TO MEMORISE", PW*0.49, C_GREEN))
LEFT.append(S(0.5))
nums_data = [
[b("Parameter"), b("Value"), b("Significance")],
["Oral Fe dose", "200 mg/day", "Correct Hb in ~6 weeks"],
["Fe stores repletion", "~6 months", "After Hb normalises"],
["TSAT cutoff", "<18% = IDA; >18% = AoCD", "Key Fe index split"],
["RI cutoff", "< 2 = hypoproliferative", "BM response marker"],
["Mentzer Index", "< 13 = Thal; > 13 = IDA", "MCV/RBC calculation"],
["HbA2 in β-thal", "> 3.5%", "β-thal trait marker"],
["Hyperseg. PMN", ">6 lobes / 5% with >5 lobes", "B12/folate def."],
]
LEFT.append(styled_table(nums_data, [PW*0.1, PW*0.19, PW*0.2], C_GREEN, fsize=6.8))
# ═══ RIGHT ═══════════════════════════════════════════════════════════════
RIGHT.append(SectionHeader("AMC-STYLE CASE QUESTIONS (WITH ANSWERS)", PW*0.49, C_PURPLE))
RIGHT.append(S(1))
cases = [
{
"q": "Q1. A 28-year-old woman presents with fatigue and heavy periods. Hb 9.2, MCV 68, RDW 18, Ferritin 4, TIBC ↑, TSAT 10%, FEP ↑. RBC count low. What is the most likely diagnosis and the SINGLE best next step?",
"a": "Dx: Iron Deficiency Anaemia (IDA). Next step: Commence oral ferrous sulphate 200 mg elemental Fe/day AND investigate source (in pre-menopausal = menorrhagia, but also exclude GI source if no clear cause or red flags).",
"pearl": "Pearl: Oral Fe gives black stools — does NOT cause false +ve FOBT.",
"col": C_LBLUE
},
{
"q": "Q2. A 55-year-old man with RA has Hb 10.1, MCV 78, Ferritin 180 (high), Fe 8 (low), TIBC 220 (low), TSAT 20%, sTfR normal, CRP ↑. What type of anaemia and what single lab best distinguishes this from IDA?",
"a": "Dx: Anaemia of Chronic Disease (AoCD). Best distinguishing test: sTfR/log Ferritin ratio (<1 in AoCD, >2 in IDA). Hepcidin elevated in AoCD. Primary Rx = treat underlying RA.",
"pearl": "Pearl: Ferritin >100 in a patient with chronic illness almost always = AoCD, even if Fe appears low.",
"col": C_LGREEN
},
{
"q": "Q3. A 3-year-old child from a Mediterranean family has Hb 6.5, MCV 60, smear shows target cells + hypochromia, splenomegaly, and Hb electrophoresis shows absent HbA, elevated HbF. Skull XR shows 'crew-cut' appearance. What is the diagnosis and first-line management?",
"a": "Dx: β-Thalassaemia Major (homozygous β°β°). Rx: Regular PRBC transfusions + iron chelation (Deferasirox OD preferred; Deferiprone for cardiac Fe). Consider allogeneic HSCT (curative).",
"pearl": "Pearl: Chipmunk facies = maxillary hypertrophy from extramedullary haematopoiesis (EMH) expansion of marrow.",
"col": C_LYELL
},
{
"q": "Q4. A 70-year-old woman develops haemolytic anaemia after starting methyldopa for hypertension. DAT is positive. What type of drug-induced haemolysis is this and what is the mechanism?",
"a": "Dx: Drug-independent autoantibody AIHA (Methyldopa type). Mechanism: drug induces true autoantibody that reacts with RBC antigens independent of drug presence. Rx: Stop methyldopa; most cases self-resolve. Steroids if severe.",
"pearl": "Pearl: Methyldopa → warm IgG AIHA (drug-independent). Penicillin → hapten IgG. Quinidine → immune complex.",
"col": C_LPURP
},
{
"q": "Q5. A 45-year-old man presents with anaemia, acrocyanosis in cold weather, and Raynaud-like symptoms. Smear: rouleaux formation. Cold agglutinin titre ↑. IgM antibody detected. What is the diagnosis and why are steroids NOT the treatment?",
"a": "Dx: Cold Agglutinin Syndrome (Cold AIHA). Steroids are ineffective because the pathogenic antibody is IgM (not IgG), produced by B-cells; steroids do not suppress IgM adequately. Rx: Avoid cold exposure + Rituximab (anti-CD20).",
"pearl": "Pearl: Warm AIHA = IgG = responds to steroids. Cold AIHA = IgM = steroids useless; use Rituximab.",
"col": C_LBLUE
},
{
"q": "Q6. A patient on anti-TB therapy (INH) develops hypochromic microcytic anaemia. BM biopsy shows ring sideroblasts. What is the diagnosis, mechanism, and specific treatment?",
"a": "Dx: Drug-induced Sideroblastic Anaemia (INH). Mechanism: INH inhibits pyridoxine (B6) → impaired ALAS2 activity → haem synthesis failure → Fe accumulates in mitochondria of erythroblasts (ring sideroblasts). Rx: Pyridoxine (Vitamin B6) supplementation.",
"pearl": "Pearl: Other reversible SA causes = alcohol, lead, copper deficiency. X-linked SA = ALAS2 mutation.",
"col": C_LGREEN
},
{
"q": "Q7. Calculate the Reticulocyte Index (RI) for a patient with: Reticulocyte count 8%, Haematocrit 20%, Normal Hct 45%. Is the bone marrow response adequate?",
"a": "Absolute Retic = 8% × (20/45) = 3.55%. MF for Hct 20% = 2.5. RI = 3.55/2.5 = 1.42. RI < 2 → Hypoproliferative response (inadequate BM response despite peripheral haemolysis/loss).",
"pearl": "Pearl: If cause is blood loss or haemolysis but RI <2, consider co-existing BM problem (Fe deficiency, B12 def, infiltration).",
"col": C_LYELL
},
]
for case in cases:
case_data = [
[Paragraph(case["q"], ps(f'cq{case["q"][:5]}', fontSize=7, leading=9.5, fontName='Helvetica-Bold'))],
[Paragraph(f"✓ {case['a']}", ps(f'ca{case["q"][:5]}', fontSize=7, leading=9.5))],
[Paragraph(f"⚡ {case['pearl']}", ps(f'cp{case["q"][:5]}', fontSize=6.8, leading=9,
fontName='Helvetica-BoldOblique', textColor=C_TEAL))],
]
ct = Table(case_data, colWidths=[PW*0.49-4])
ct.setStyle(TableStyle([
('BACKGROUND', (0,0),(0,0), case["col"]),
('BACKGROUND', (0,1),(0,1), colors.white),
('BACKGROUND', (0,2),(0,2), C_LGRAY),
('BOX', (0,0),(0,-1), 0.8, C_NAVY),
('LINEBELOW', (0,0),(0,1), 0.4, C_MGRAY),
('TOPPADDING', (0,0),(0,-1), 3),
('BOTTOMPADDING', (0,0),(0,-1), 3),
('LEFTPADDING', (0,0),(0,-1), 5),
('RIGHTPADDING', (0,0),(0,-1), 5),
]))
RIGHT.append(ct)
RIGHT.append(S(1.2))
# ── master table ─────────────────────────────────────────────────────────
master = Table([[LEFT, RIGHT]], colWidths=[PW*0.49, PW*0.49])
master.setStyle(TableStyle([
('VALIGN', (0,0),(-1,-1), 'TOP'),
('LEFTPADDING', (0,0),(-1,-1), 0),
('RIGHTPADDING', (0,0),(-1,-1), 0),
('TOPPADDING', (0,0),(-1,-1), 0),
('BOTTOMPADDING',(0,0),(-1,-1), 0),
('INNERGRID', (0,0),(-1,-1), 0.5, C_MGRAY),
]))
elements.append(master)
elements.append(Spacer(1, 2*mm))
elements.append(HRFlowable(width=PW, color=C_MGRAY))
elements.append(Paragraph(
col("Page 2 of 2 | OSCE Pearls + AMC Cases | Approach to Anaemia Part 1 | © 2026", "#888888"),
ps('footer2', fontSize=6, leading=8, alignment=TA_CENTER)))
# ══════════════════════════════════════════════════════════════════════════════
# MAIN BUILD
# ══════════════════════════════════════════════════════════════════════════════
def main():
M = 10*mm # margins
PW = W - 2*M
doc = SimpleDocTemplate(
OUTPUT,
pagesize=A4,
leftMargin=M, rightMargin=M,
topMargin=8*mm, bottomMargin=8*mm,
title="Anaemia Revision Notes",
)
elements = []
build_page1(elements, PW)
build_page2(elements, PW)
doc.build(elements)
print(f"✅ PDF created: {OUTPUT}")
if __name__ == "__main__":
main()
cd /home/daytona/workspace/anemia-notes && python3 build_notes.py 2>&1
~/anemia-notes/build_notes.py
Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/anemia-notes/build_notes.py'
cd /home/daytona/workspace/anemia-notes && python3 build_notes.py 2>&1
~/anemia-notes/build_notes.py
Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/anemia-notes/build_notes.py'
cd /home/daytona/workspace/anemia-notes && python3 -c " import ast, sys with open('build_notes.py') as f: src = f.read() try: ast.parse(src) print('Syntax OK') except SyntaxError as e: print(f'SyntaxError at line {e.lineno}: {e.msg}') # print surrounding lines lines = src.split('\n') for i in range(max(0,e.lineno-3), min(len(lines), e.lineno+2)): print(f'{i+1}: {lines[i]}') "
cd /home/daytona/workspace/anemia-notes && python3 build_notes.py 2>&1
~/anemia-notes/build_notes.py
"""
Anaemia Revision Notes - 2 page PDF
Uses direct canvas drawing to avoid nested-table overflow issues.
"""
from reportlab.pdfgen import canvas as pdfcanvas
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.platypus import (Table, TableStyle, Paragraph, SimpleDocTemplate,
Spacer, HRFlowable, PageBreak, KeepTogether)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT
from reportlab.platypus.flowables import Flowable
W, H = A4
# Palette
C_NAVY = colors.HexColor("#1A3A5C")
C_TEAL = colors.HexColor("#0E7C7B")
C_AMBER = colors.HexColor("#F4A300")
C_RED = colors.HexColor("#C0392B")
C_PURPLE = colors.HexColor("#6C3483")
C_GREEN = colors.HexColor("#1E8449")
C_ORANGE = colors.HexColor("#E67E22")
C_LGRAY = colors.HexColor("#F2F4F4")
C_MGRAY = colors.HexColor("#D5D8DC")
C_LBLUE = colors.HexColor("#D6EAF8")
C_LGREEN = colors.HexColor("#D5F5E3")
C_LYELL = colors.HexColor("#FEF9E7")
C_LPURP = colors.HexColor("#F4ECF7")
OUTPUT = "/home/daytona/workspace/anemia-notes/Anemia_Revision_Notes.pdf"
styles = getSampleStyleSheet()
def ps(name, **kw):
return ParagraphStyle(name, parent=styles['Normal'], **kw)
tiny = ps('tiny', fontSize=6.6, leading=8.5)
tiny_b = ps('tiny_b', fontSize=6.6, leading=8.5, fontName='Helvetica-Bold')
body = ps('body', fontSize=7.2, leading=9.5)
body_b = ps('body_b', fontSize=7.2, leading=9.5, fontName='Helvetica-Bold')
head = ps('head', fontSize=9, leading=11, fontName='Helvetica-Bold')
ctr = ps('ctr', fontSize=7, leading=9, alignment=TA_CENTER)
foot_s = ps('foot_s', fontSize=6, leading=8, alignment=TA_CENTER,
textColor=colors.HexColor("#888888"))
def b(t): return f"<b>{t}</b>"
def red(t): return f'<font color="#C0392B">{t}</font>'
def grn(t): return f'<font color="#1E8449">{t}</font>'
def blu(t): return f'<font color="#1A3A5C">{t}</font>'
def pur(t): return f'<font color="#6C3483">{t}</font>'
# ── Table builder ─────────────────────────────────────────────────────────────
def mk_table(data, widths, hdr_bg=C_NAVY, fsize=6.6, alt=True):
ts = [
('BACKGROUND', (0,0), (-1,0), hdr_bg),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,-1), fsize),
('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
('TOPPADDING', (0,0), (-1,-1), 2),
('BOTTOMPADDING',(0,0), (-1,-1), 2),
('LEFTPADDING', (0,0), (-1,-1), 3),
('RIGHTPADDING', (0,0), (-1,-1), 3),
('GRID', (0,0), (-1,-1), 0.3, C_MGRAY),
]
if alt:
ts.append(('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.white, C_LGRAY]))
t = Table(data, colWidths=widths)
t.setStyle(TableStyle(ts))
return t
def section_hdr(title, width, bg=C_NAVY, fsize=8.5):
"""Coloured section header row."""
d = [[Paragraph(f'<font color="white"><b>{title}</b></font>',
ps(f'sh{title[:6]}', fontSize=fsize, leading=fsize+3))]]
t = Table(d, colWidths=[width])
t.setStyle(TableStyle([
('BACKGROUND', (0,0),(-1,-1), bg),
('TOPPADDING', (0,0),(-1,-1), 3),
('BOTTOMPADDING', (0,0),(-1,-1), 3),
('LEFTPADDING', (0,0),(-1,-1), 5),
]))
return t
def sp(n): return Spacer(1, n*mm)
# ── Horizontal Flow Arrow ─────────────────────────────────────────────────────
class HFlow(Flowable):
def __init__(self, steps, total_w, box_h=28, fsize=6.5, clrs=None):
Flowable.__init__(self)
self.steps = steps
n = len(steps)
arr = 9
self.box_w = (total_w - arr*(n-1)) / n
self.arr = arr
self.box_h = box_h
self.fsize = fsize
self.clrs = clrs or [C_NAVY]*n
self.width = total_w
self.height = box_h
def draw(self):
c = self.canv
n = len(self.steps)
for i, (txt, col) in enumerate(zip(self.steps, self.clrs)):
x = i * (self.box_w + self.arr)
c.setFillColor(col)
c.setStrokeColor(colors.white)
c.roundRect(x, 0, self.box_w, self.box_h, 3, fill=1, stroke=1)
c.setFillColor(colors.white)
c.setFont("Helvetica-Bold", self.fsize)
lines = txt.split('\n')
lh = self.fsize + 1.8
tot = lh * len(lines)
sy = (self.box_h + tot) / 2 - self.fsize
for j, ln in enumerate(lines):
c.drawCentredString(x + self.box_w/2, sy - j*lh, ln)
if i < n-1:
ax = x + self.box_w + 0.5
ay = self.box_h / 2
c.setFillColor(C_AMBER)
p = c.beginPath()
p.moveTo(ax, ay)
p.lineTo(ax + self.arr - 1, ay + 3.5)
p.lineTo(ax + self.arr - 1, ay - 3.5)
p.close()
c.drawPath(p, fill=1, stroke=0)
# ─────────────────────────────────────────────────────────────────────────────
# PAGE 1
# ─────────────────────────────────────────────────────────────────────────────
def page1_elements(PW):
elems = []
LW = PW * 0.478
RW = PW * 0.478
gap = PW * 0.044
# Title
title = [[Paragraph(
'<font color="white"><b> ANAEMIA PART-1 — LAST-MINUTE REVISION | Approach, Classification, Differentials, Thalassaemia, AIHA</b></font>',
ps('ti1', fontSize=10.5, leading=13))]]
tt = Table(title, colWidths=[PW])
tt.setStyle(TableStyle([
('BACKGROUND', (0,0),(-1,-1), C_NAVY),
('TOPPADDING', (0,0),(-1,-1), 6),
('BOTTOMPADDING', (0,0),(-1,-1), 6),
('LEFTPADDING', (0,0),(-1,-1), 6),
]))
elems.append(tt)
elems.append(sp(1.5))
# ---------- Build LEFT and RIGHT columns as lists ----------
LEFT = []
RIGHT = []
# === LEFT ===
# 1. RI calculation
LEFT.append(section_hdr("1 RETICULOCYTE INDEX (RI)", LW, C_NAVY))
LEFT.append(sp(0.8))
ri_steps = [
"Lab gives\nRetic %",
"Abs Retic\n= Retic% x\nPt Hct/45",
"RI = Abs Retic\n/ MF",
"RI < 2\nHypoprolif.\n(BM failure)",
"RI >= 2\nHyperprolif.\n(Haemolysis)"
]
LEFT.append(HFlow(ri_steps, LW, box_h=30, fsize=6.5,
clrs=[C_TEAL,C_TEAL,C_NAVY,C_RED,C_GREEN]))
LEFT.append(sp(0.8))
mf = mk_table(
[[b("Pt Hct"), b("MF (Maturation Factor)")],
[">35%","1.0"], ["25-35%","1.5"], ["20-25%","2.0"], ["<20%","2.5"]],
[LW*0.3, LW*0.7], C_TEAL, fsize=7)
LEFT.append(mf)
LEFT.append(sp(1.5))
# 2. Classification
LEFT.append(section_hdr("2 CLASSIFICATION BY MCV", LW, C_PURPLE))
LEFT.append(sp(0.8))
cls = mk_table(
[[b("MCV"), b("Type"), b("Causes")],
[red("<80\nMicro"), "Microcytic", "IDA, Thal, SA, AoCD"],
[blu("80-100\nNormo"), "Normocytic", "Acute blood loss, Haemolysis,\nAoCD early, CKD, BM failure"],
[grn(">100\nMacro"), "Macrocytic", "B12/Folate def, Drugs*\nLiver dis, Hypothyroid"]],
[LW*0.12, LW*0.18, LW*0.70], C_PURPLE, fsize=6.8)
LEFT.append(cls)
LEFT.append(sp(0.5))
LEFT.append(Paragraph(
b("*Megaloblastic drugs: ") +
"Anti-cancer drugs, Folate antagonists, Biguanides (Metformin), "
"Anti-epileptics, ART, Nitrous Oxide", tiny))
LEFT.append(sp(1.5))
# 3. Microcytic defect
LEFT.append(section_hdr("3 MICROCYTIC — WHERE IS THE DEFECT?", LW, C_RED))
LEFT.append(sp(0.8))
LEFT.append(HFlow(
["Globin defect\nTHALASSAEMIA",
"Heme/Fe defect\nIDA",
"Heme/Fe defect\nSIDEROBLASTIC",
"Fe trapped\nin RE: AoCD"],
LW, box_h=22, fsize=6.6,
clrs=[C_PURPLE, C_RED, C_ORANGE, C_TEAL]))
LEFT.append(sp(1.5))
# 4. Haemolysis EV vs IV
LEFT.append(section_hdr("4 HAEMOLYSIS: EV vs IV", LW, C_ORANGE))
LEFT.append(sp(0.8))
hemo = mk_table(
[[b("Feature"), b("Extravascular (EV)"), b("Intravascular (IV)")],
["Spherocytes", "MORE common", "Less"],
["Splenomegaly", "YES", "Rare"],
["Haptoglobin", "Low", "Very Low"],
["Haemosiderinuria","No", "Yes (chronic)"],
["Bilirubin/Stones","YES", "Less"],
["LDH", "Elevated", "Elevated++"],
["Haemoglob-inuria","No", "Yes (acute)"]],
[LW*0.27, LW*0.365, LW*0.365], C_ORANGE, fsize=6.6)
LEFT.append(hemo)
LEFT.append(sp(0.5))
LEFT.append(Paragraph(
b("Leukoerythroblastic picture: ") +
"Dacrocytes, Nucleated RBC, Immature WBC, Hepatosplenomegaly. "
b("Hyperseg neutrophils: ") + "Single PMN >6 lobes OR >5% PMN with >5 lobes (= B12/folate def)",
tiny))
# === RIGHT ===
# 5. Differential table
RIGHT.append(section_hdr("5 MICROCYTIC DIFFERENTIALS", RW, C_TEAL))
RIGHT.append(sp(0.8))
diff = mk_table(
[[b("Lab"), b("IDA"), b("AoCD"), b("Thal Trait"), b("SA")],
["RBC/Retic", "Low\n(MI>13)", "Low", "High\n(MI<13)", "Low"],
["RDW", "High", "Normal", "Normal", "High"],
["Serum Fe", "Low", "Low", "Normal/High", "High"],
["Ferritin", "Low", "HIGH", "Normal", "High"],
["sTfR", "High", "Normal", "Normal", "Normal"],
["TIBC", "High", "Low", "Normal", "Normal"],
["TSAT", "<18%", ">18%", "High", "High"],
["sTfR/logFer",">2", "<1", "-", "-"],
["Hepcidin", "Low", "HIGH", "Normal", "-"],
["FEP", "High", "High", "Normal", "High"],
["BM Fe", "Absent", "Present", "Present", "Present+RS"],
["Electrophor","Normal", "Normal", "ABNORMAL", "Normal"],
["Rx", "Oral/IV Fe", "Rx cause\n+/-Fe+/-ESA", "None specific",
"Reversible causes +/- Pyridoxine"]],
[RW*0.14, RW*0.17, RW*0.17, RW*0.17, RW*0.35], C_TEAL, fsize=6.4)
RIGHT.append(diff)
RIGHT.append(sp(0.5))
RIGHT.append(Paragraph(
b("Oral Fe: ") + "200 mg/day. 6 wks = Hb corrects. 6 months = Fe stores replete. "
"Poor response (<2g/dL rise in 3 wks): non-compliance, ongoing bleed, malabsorption, wrong Dx, mixed deficiency. "
"Absorption reduced by: Ca, PPIs/H2RA, phytates, phosphates, tannates. "
b("Fe gluconate ") + "12% | " + b("Fe sulphate ") + "20% | " + b("Fe fumarate ") + "35% elemental Fe. "
b("IV Fe indications: ") + "Intolerance, malabsorption, pre-ESA, CKD-HD, cancer, CHF, IRIDA.",
tiny))
RIGHT.append(sp(1.5))
# 6. Thalassaemia
RIGHT.append(section_hdr("6 THALASSAEMIA", RW, C_PURPLE))
RIGHT.append(sp(0.8))
thal = mk_table(
[[b("Type"), b("Genotype / Deletions"), b("Clinical")],
[pur("Alpha-Thal"), "1 deletion", "Silent carrier"],
["", "2 deletions", "Asymptomatic + mild anaemia"],
["", "3 deletions", "HbH disease"],
["", "4 deletions", "Death in utero (Hb Barts)"],
[pur("Beta-Thal"), "B0B0 or B+B+", "Thal MAJOR (transfusion-dependent)"],
["", "B0B or B+B", "Thal MINOR (asymptomatic)"],
["", "B0B+ compound het", "Thal major/intermedia"],
["", "HbSB0 / HbEB0", "Thal major phenotype"]],
[RW*0.14, RW*0.32, RW*0.54], C_PURPLE, fsize=6.5)
RIGHT.append(thal)
RIGHT.append(sp(0.5))
RIGHT.append(Paragraph(
b("Beta-Thal Major features: ") +
"Chipmunk facies, Crew-cut skull XR, Pathologic fractures, HSM (EMH), High-output HF, Bilirubin gallstones, Fe overload. " +
b("Rx: ") + "Regular PRBC transfusions + Fe chelators +/- splenectomy. " +
b("Chelators: ") + "IV Deferoxamine | Oral Deferiprone TID (BEST for cardiac Fe) | Oral Deferasirox OD (preferred overall). " +
b("Screen: ") + "Nestroft test. Alpha = AR deletions. Beta = AR point/frameshift mutations (B+ = promoter/splicing; B0 = exon stop).",
tiny))
RIGHT.append(sp(1.5))
# 7. AIHA
RIGHT.append(section_hdr("7 AUTOIMMUNE HAEMOLYTIC ANAEMIA (AIHA)", RW, C_RED))
RIGHT.append(sp(0.8))
aiha = mk_table(
[[b("Feature"), b("Warm AIHA"), b("Cold Agg. Syn."), b("PCH")],
["Incidence", "70%", "10-15%", "1-2%"],
["Ab type", "IgG", "IgM", "IgG (biphasic)"],
["Complement","Not activated", "Activated", "Activated"],
["Temp", "37C", "<37C", "Biphasic"],
["Haemolysis","Mostly EV", "Mostly IV", "IV"],
["Smear", "Spherocytes", "Rouleaux/Agg", "Spherocytes"],
["Clinical", "Fever, jaundice,\nsplenomegaly",
"Chronic anaemia\n+ acrocyanosis", "Post-infection\nacute haemolysis"],
["Etiology", "Idiopathic, CTD,\nNeoplasm, Drugs,\nInfections",
"Monoclonal/\nPolyclonal, Drugs", "Idiopathic,\nInfections"],
["Rx", "Steroids, IVIg,\nRituximab,\nSplenectomy",
"Avoid cold\n+ Rituximab\n(STEROIDS FAIL)",
"Supportive,\nAvoid cold"]],
[RW*0.14, RW*0.27, RW*0.27, RW*0.32], C_RED, fsize=6.4)
RIGHT.append(aiha)
RIGHT.append(sp(0.5))
RIGHT.append(Paragraph(
b("Drug AIHA mechanisms: ") +
"1. Hapten = beta-lactams (Penicillin) — IgG coats drug-coated RBC. "
"2. Immune complex = Quinidine — complement activation. "
"3. Drug-independent autoantibody = Methyldopa — true warm IgG AIHA.",
tiny))
# Pack into 2-col table
col_gap = [[sp(0)]]
all_cols = Table(
[[LEFT, col_gap, RIGHT]],
colWidths=[LW, gap, RW]
)
all_cols.setStyle(TableStyle([
('VALIGN', (0,0),(-1,-1), 'TOP'),
('LEFTPADDING', (0,0),(-1,-1), 0),
('RIGHTPADDING', (0,0),(-1,-1), 0),
('TOPPADDING', (0,0),(-1,-1), 0),
('BOTTOMPADDING', (0,0),(-1,-1), 0),
]))
elems.append(all_cols)
elems.append(sp(1))
elems.append(HRFlowable(width=PW, color=C_MGRAY, thickness=0.5))
elems.append(Paragraph(
"Page 1 of 2 | Approach to Anaemia Part 1 | Last-Minute Revision",
foot_s))
return elems
# ─────────────────────────────────────────────────────────────────────────────
# PAGE 2
# ─────────────────────────────────────────────────────────────────────────────
def page2_elements(PW):
elems = []
elems.append(PageBreak())
LW = PW * 0.478
RW = PW * 0.478
gap = PW * 0.044
# Title
title = [[Paragraph(
'<font color="white"><b> OSCE PEARLS & AMC-STYLE CASE QUESTIONS — ANAEMIA PART 1</b></font>',
ps('ti2', fontSize=10.5, leading=13))]]
tt = Table(title, colWidths=[PW])
tt.setStyle(TableStyle([
('BACKGROUND', (0,0),(-1,-1), C_RED),
('TOPPADDING', (0,0),(-1,-1), 6),
('BOTTOMPADDING', (0,0),(-1,-1), 6),
('LEFTPADDING', (0,0),(-1,-1), 6),
]))
elems.append(tt)
elems.append(sp(1.5))
LEFT = []
RIGHT = []
# ── LEFT: OSCE PEARLS ───────────────────────────────────────────────────
pearl_sections = [
("IDA PEARLS", C_RED, [
"Koilonychia + pallor + pica = IDA until proven otherwise",
"Oral Fe: black stools = NORMAL, does NOT cause false +ve FOBT",
"Best absorbed = Ferrous FUMARATE (35% elemental Fe)",
"Check menstrual history + NSAIDs use + GI symptoms",
"Poor response in 3 wks: non-compliance, ongoing bleed, malabsorption, wrong Dx",
"IRIDA = Iron-refractory IDA (TMPRSS6 mutation) = must use IV Fe",
]),
("AoCD PEARLS", C_ORANGE, [
"Ferritin = acute-phase reactant: HIGH in AoCD even though Fe is low",
"Key ratio: sTfR/log Ferritin >2 = IDA; <1 = AoCD",
"Hepcidin HIGH in AoCD (blocks ferroportin, traps Fe in macrophages)",
"TSAT >18% + low Fe + high Ferritin = AoCD pattern",
"Primary Rx = treat the underlying cause",
]),
("THALASSAEMIA PEARLS", C_PURPLE, [
"Low MCV + NORMAL RDW + HIGH RBC = Thal trait (IDA has HIGH RDW)",
"Mentzer Index = MCV/RBC: <13 = Thal, >13 = IDA",
"Beta-thal trait: HbA2 >3.5% on electrophoresis",
"Deferiprone TID = BEST for cardiac iron removal",
"Deferasirox OD = preferred overall chelator",
"HSCT = only curative option for Thal Major",
"HbH (3-deletion alpha-thal) = HbH inclusions on BCB stain",
]),
("SIDEROBLASTIC ANAEMIA PEARLS", C_TEAL, [
"Ring sideroblasts on Prussian blue BM stain = pathognomonic",
"Reversible causes: ALCOHOL, INH, Lead, Cu deficiency",
"INH mechanism: inhibits B6 (pyridoxine) → impairs ALAS2 → Rx = Pyridoxine",
"X-linked SA: ALAS2 gene mutation (responds to pyridoxine)",
"Acquired SA: MDS-RARS (now MDS with ring sideroblasts, SF3B1 mutation)",
"Fe indices ALL elevated (confusable with haemochromatosis)",
]),
("HAEMOLYSIS PEARLS", C_ORANGE, [
"DAT (Coombs) +ve = AIHA. DAT -ve = hereditary spherocytosis, G6PD, TTP",
"G6PD: Heinz bodies + bite cells; oxidant drugs = primaquine, dapsone, fava beans",
"Warm AIHA (IgG) = steroids work. Cold AIHA (IgM) = STEROIDS FAIL, use Rituximab",
"PCH: IgG biphasic (attaches cold, lyses warm) = children post-viral",
"Drug AIHA: Penicillin=hapten | Quinidine=immune complex | Methyldopa=autoantibody",
]),
("KEY NUMBERS", C_GREEN, [
"Oral Fe: 200 mg/day | 6 weeks to correct Hb | 6 months to replete stores",
"RI <2 = hypoproliferative BM | RI >=2 = hyperproliferative",
"TSAT <18% = IDA | TSAT >18% = AoCD",
"Mentzer Index <13 = Thal | >13 = IDA",
"HbA2 >3.5% = beta-thal trait",
"Hyperseg PMN: >6 lobes in 1 cell OR >5% cells with >5 lobes = B12/folate def",
"MF: Hct >35%=1.0 | 25-35%=1.5 | 20-25%=2.0 | <20%=2.5",
]),
]
for title_ps, bg, pts in pearl_sections:
LEFT.append(section_hdr(title_ps, LW, bg, fsize=8))
LEFT.append(sp(0.5))
for pt in pts:
LEFT.append(Paragraph(f"<bullet>•</bullet> {pt}",
ps(f'bl{pt[:8]}', fontSize=7, leading=9.5,
leftIndent=10, bulletIndent=0)))
LEFT.append(sp(1))
# ── RIGHT: AMC CASES ────────────────────────────────────────────────────
RIGHT.append(section_hdr("AMC-STYLE CASE QUESTIONS (Q then Answer + Pearl)", RW, C_NAVY))
RIGHT.append(sp(1))
cases = [
{
"n": "Q1. IDA",
"q": "28F, fatigue, menorrhagia. Hb 9.2, MCV 68, RDW 18, Ferritin 4, TIBC high, TSAT 10%, FEP high, RBC low. Best diagnosis and immediate management?",
"a": "DX: Iron Deficiency Anaemia. RX: Ferrous sulphate 200 mg elemental Fe/day. Investigate source: menorrhagia confirmed, but also exclude GI source if >40y or red flags. Recheck Hb in 3 weeks.",
"p": "Black stools from oral Fe = normal, NOT a +ve FOBT. If Hb rise <2g/dL in 3 wks think non-compliance/ongoing bleed.",
"bg": C_LBLUE,
},
{
"n": "Q2. AoCD vs IDA",
"q": "55M with RA. Hb 10.1, MCV 78, Ferritin 180, Fe low, TIBC 220 (low), TSAT 20%, sTfR normal, CRP elevated. What is the Dx and which SINGLE test distinguishes this from IDA?",
"a": "DX: Anaemia of Chronic Disease. Best test: sTfR/log Ferritin ratio (<1 in AoCD vs >2 in IDA). Hepcidin elevated. RX: Treat underlying RA. Add IV Fe +/- ESA if symptomatic.",
"p": "Ferritin >100 in chronic illness = almost always AoCD even if serum Fe appears low. Hepcidin is the key regulator.",
"bg": C_LGREEN,
},
{
"n": "Q3. Beta-Thal Major",
"q": "3yo Mediterranean child, Hb 6.5, MCV 60, target cells, splenomegaly. Electrophoresis: absent HbA, elevated HbF. Skull XR: crew-cut. Diagnosis and treatment?",
"a": "DX: Beta-Thalassaemia Major (B0B0 homozygous). RX: Regular PRBC transfusions + Fe chelation. Preferred chelator = Deferasirox OD. For cardiac Fe = Deferiprone TID. Curative = Allogeneic HSCT.",
"p": "Chipmunk facies = maxillary marrow expansion (EMH). Crew-cut XR = perpendicular bone trabeculae in skull diploe. Both = classic Thal Major.",
"bg": C_LYELL,
},
{
"n": "Q4. Drug AIHA - Methyldopa",
"q": "70F develops haemolytic anaemia on methyldopa for hypertension. DAT positive. What type of drug AIHA and mechanism?",
"a": "DX: Drug-independent autoantibody AIHA (Methyldopa). Mechanism: drug induces true autoantibody against RBC antigens that persists even after drug stopped. RX: Stop methyldopa. Steroids if severe. Usually self-resolves.",
"p": "Methyldopa = autoantibody (drug-independent, IgG warm). Penicillin = hapten (IgG, drug must be present). Quinidine = immune complex (IgM/IgG, complement, severe IV haemolysis).",
"bg": C_LPURP,
},
{
"n": "Q5. Cold AIHA",
"q": "45M with anaemia and acrocyanosis in winter. Smear shows rouleaux. IgM cold agglutinins detected. Why are corticosteroids NOT appropriate treatment?",
"a": "DX: Cold Agglutinin Syndrome. Steroids are INEFFECTIVE because pathogenic antibody is IgM (not IgG); steroids reduce IgG but not IgM significantly. RX: Avoid cold exposure + Rituximab (anti-CD20).",
"p": "Warm AIHA = IgG = steroids work. Cold AIHA = IgM = steroids fail. This distinction is a classic AMC/OSCE stem trap.",
"bg": C_LBLUE,
},
{
"n": "Q6. Sideroblastic Anaemia - INH",
"q": "Patient on INH for TB develops microcytic anaemia. BM shows ring sideroblasts. Diagnosis, mechanism, specific treatment?",
"a": "DX: INH-induced Sideroblastic Anaemia. Mechanism: INH inhibits pyridoxine (B6) which is cofactor for ALAS2 (rate-limiting enzyme of haem synthesis). Fe accumulates in mitochondria = ring sideroblasts. RX: Pyridoxine (Vitamin B6).",
"p": "ALAS2 is the rate-limiting enzyme of haem synthesis. B6 cofactor. Other SA causes: alcohol, lead, Cu def. Give pyridoxine prophylactically with INH in high-risk patients.",
"bg": C_LGREEN,
},
{
"n": "Q7. RI Calculation",
"q": "Retic count 8%, Haematocrit 20%, Normal Hct 45%. Calculate RI. Is BM response adequate?",
"a": "Abs Retic = 8% x (20/45) = 3.56%. MF for Hct 20% = 2.5. RI = 3.56 / 2.5 = 1.42. RI <2 = HYPOPROLIFERATIVE = inadequate BM response. Despite peripheral cause, there is co-existing BM failure (suspect Fe/B12 deficiency or infiltration).",
"p": "If cause appears to be haemolysis or blood loss but RI <2, always suspect a co-existing BM problem suppressing the response.",
"bg": C_LYELL,
},
]
for case in cases:
q_para = Paragraph(b(case["n"] + ": ") + case["q"],
ps(f'cq{case["n"][:4]}', fontSize=7, leading=9.5))
a_para = Paragraph(b("A: ") + case["a"],
ps(f'ca{case["n"][:4]}', fontSize=7, leading=9.5))
p_para = Paragraph(b("Pearl: ") + case["p"],
ps(f'cp{case["n"][:4]}', fontSize=6.8, leading=9,
fontName='Helvetica-BoldOblique',
textColor=C_TEAL))
card = Table(
[[q_para], [a_para], [p_para]],
colWidths=[RW]
)
card.setStyle(TableStyle([
('BACKGROUND', (0,0),(0,0), case["bg"]),
('BACKGROUND', (0,1),(0,1), colors.white),
('BACKGROUND', (0,2),(0,2), C_LGRAY),
('BOX', (0,0),(0,-1), 0.7, C_NAVY),
('LINEBELOW', (0,0),(0,1), 0.3, C_MGRAY),
('TOPPADDING', (0,0),(0,-1), 3),
('BOTTOMPADDING', (0,0),(0,-1), 3),
('LEFTPADDING', (0,0),(0,-1), 5),
('RIGHTPADDING', (0,0),(0,-1), 5),
]))
RIGHT.append(card)
RIGHT.append(sp(1.5))
# Two-column
col_gap = [[sp(0)]]
all_cols = Table(
[[LEFT, col_gap, RIGHT]],
colWidths=[LW, gap, RW]
)
all_cols.setStyle(TableStyle([
('VALIGN', (0,0),(-1,-1), 'TOP'),
('LEFTPADDING', (0,0),(-1,-1), 0),
('RIGHTPADDING', (0,0),(-1,-1), 0),
('TOPPADDING', (0,0),(-1,-1), 0),
('BOTTOMPADDING', (0,0),(-1,-1), 0),
]))
elems.append(all_cols)
elems.append(sp(1))
elems.append(HRFlowable(width=PW, color=C_MGRAY, thickness=0.5))
elems.append(Paragraph(
"Page 2 of 2 | OSCE Pearls + AMC Cases | Approach to Anaemia Part 1",
foot_s))
return elems
# ─────────────────────────────────────────────────────────────────────────────
# MAIN
# ─────────────────────────────────────────────────────────────────────────────
def main():
M = 9 * mm
PW = W - 2*M
doc = SimpleDocTemplate(
OUTPUT,
pagesize=A4,
leftMargin=M, rightMargin=M,
topMargin=8*mm, bottomMargin=8*mm,
title="Anaemia Revision Notes",
author="Orris",
)
elements = []
elements += page1_elements(PW)
elements += page2_elements(PW)
doc.build(elements)
print(f"PDF saved: {OUTPUT}")
if __name__ == "__main__":
main()
cat > /home/daytona/workspace/anemia-notes/build_notes.py << 'PYEOF' """ Anaemia Revision Notes - 2 page PDF Uses direct canvas drawing to avoid nested-table overflow issues. """ from reportlab.pdfgen import canvas as pdfcanvas from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import mm from reportlab.platypus import (Table, TableStyle, Paragraph, SimpleDocTemplate, Spacer, HRFlowable, PageBreak, KeepTogether) from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from reportlab.platypus.flowables import Flowable W, H = A4 C_NAVY = colors.HexColor("#1A3A5C") C_TEAL = colors.HexColor("#0E7C7B") C_AMBER = colors.HexColor("#F4A300") C_RED = colors.HexColor("#C0392B") C_PURPLE = colors.HexColor("#6C3483") C_GREEN = colors.HexColor("#1E8449") C_ORANGE = colors.HexColor("#E67E22") C_LGRAY = colors.HexColor("#F2F4F4") C_MGRAY = colors.HexColor("#D5D8DC") C_LBLUE = colors.HexColor("#D6EAF8") C_LGREEN = colors.HexColor("#D5F5E3") C_LYELL = colors.HexColor("#FEF9E7") C_LPURP = colors.HexColor("#F4ECF7") OUTPUT = "/home/daytona/workspace/anemia-notes/Anemia_Revision_Notes.pdf" styles = getSampleStyleSheet() def ps(name, **kw): return ParagraphStyle(name, parent=styles['Normal'], **kw) tiny = ps('tiny_g', fontSize=6.6, leading=8.5) foot_s = ps('foot_sg', fontSize=6, leading=8, alignment=TA_CENTER, textColor=colors.HexColor("#888888")) def b(t): return f"<b>{t}</b>" def red(t): return f'<font color="#C0392B">{t}</font>' def grn(t): return f'<font color="#1E8449">{t}</font>' def blu(t): return f'<font color="#1A3A5C">{t}</font>' def pur(t): return f'<font color="#6C3483">{t}</font>' def mk_table(data, widths, hdr_bg=C_NAVY, fsize=6.6): ts = [ ('BACKGROUND', (0,0), (-1,0), hdr_bg), ('TEXTCOLOR', (0,0), (-1,0), colors.white), ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'), ('FONTSIZE', (0,0), (-1,-1), fsize), ('VALIGN', (0,0), (-1,-1), 'MIDDLE'), ('TOPPADDING', (0,0), (-1,-1), 2), ('BOTTOMPADDING',(0,0), (-1,-1), 2), ('LEFTPADDING', (0,0), (-1,-1), 3), ('RIGHTPADDING', (0,0), (-1,-1), 3), ('GRID', (0,0), (-1,-1), 0.3, C_MGRAY), ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.white, C_LGRAY]), ] t = Table(data, colWidths=widths) t.setStyle(TableStyle(ts)) return t def shdr(title, width, bg=C_NAVY, fsize=8.5): d = [[Paragraph(f'<font color="white"><b>{title}</b></font>', ps(f'sh_{title[:8]}', fontSize=fsize, leading=fsize+3))]] t = Table(d, colWidths=[width]) t.setStyle(TableStyle([ ('BACKGROUND', (0,0),(-1,-1), bg), ('TOPPADDING', (0,0),(-1,-1), 3), ('BOTTOMPADDING', (0,0),(-1,-1), 3), ('LEFTPADDING', (0,0),(-1,-1), 5), ])) return t def sp(n): return Spacer(1, n*mm) class HFlow(Flowable): def __init__(self, steps, total_w, box_h=28, fsize=6.5, clrs=None): Flowable.__init__(self) self.steps = steps n = len(steps) arr = 9 self.box_w = (total_w - arr*(n-1)) / n self.arr = arr self.box_h = box_h self.fsize = fsize self.clrs = clrs or [C_NAVY]*n self.width = total_w self.height = box_h def draw(self): c = self.canv n = len(self.steps) for i, (txt, col) in enumerate(zip(self.steps, self.clrs)): x = i * (self.box_w + self.arr) c.setFillColor(col) c.setStrokeColor(colors.white) c.roundRect(x, 0, self.box_w, self.box_h, 3, fill=1, stroke=1) c.setFillColor(colors.white) c.setFont("Helvetica-Bold", self.fsize) lines = txt.split('\n') lh = self.fsize + 1.8 tot = lh * len(lines) sy = (self.box_h + tot) / 2 - self.fsize for j, ln in enumerate(lines): c.drawCentredString(x + self.box_w/2, sy - j*lh, ln) if i < n-1: ax = x + self.box_w + 0.5 ay = self.box_h / 2 c.setFillColor(C_AMBER) p = c.beginPath() p.moveTo(ax, ay) p.lineTo(ax + self.arr - 1, ay + 3.5) p.lineTo(ax + self.arr - 1, ay - 3.5) p.close() c.drawPath(p, fill=1, stroke=0) def two_col(left_items, right_items, lw, rw, gap_w): gap_item = [sp(0)] t = Table([[left_items, gap_item, right_items]], colWidths=[lw, gap_w, rw]) t.setStyle(TableStyle([ ('VALIGN', (0,0),(-1,-1), 'TOP'), ('LEFTPADDING', (0,0),(-1,-1), 0), ('RIGHTPADDING', (0,0),(-1,-1), 0), ('TOPPADDING', (0,0),(-1,-1), 0), ('BOTTOMPADDING', (0,0),(-1,-1), 0), ])) return t # ───────────────────────────────────────────────────────────────────────────── def page1(PW): elems = [] LW = PW*0.478; RW = PW*0.478; GW = PW*0.044 # Title tt = Table([[Paragraph( '<font color="white"><b> ANAEMIA PART-1 | LAST-MINUTE REVISION | Approach, Classification, Differentials, Thalassaemia, AIHA</b></font>', ps('ti1g', fontSize=10.5, leading=13))]], colWidths=[PW]) tt.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),C_NAVY), ('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6),('LEFTPADDING',(0,0),(-1,-1),6)])) elems.append(tt); elems.append(sp(1.5)) L=[]; R=[] # LEFT ──────────────────────────────────────────────────────────────────── L.append(shdr("1 RETICULOCYTE INDEX (RI)", LW, C_NAVY)); L.append(sp(0.8)) L.append(HFlow( ["Lab Retic %","Abs Retic\n= Retic% x\nPtHct/45","RI =\nAbsRetic/MF","RI < 2\nHypoprolif.\nBM failure","RI >= 2\nHyperprolif.\nHaemolysis"], LW, box_h=30, fsize=6.5, clrs=[C_TEAL,C_TEAL,C_NAVY,C_RED,C_GREEN])) L.append(sp(0.8)) L.append(mk_table([[b("Pt Hct"),b("MF")],[">35%","1.0"],["25-35%","1.5"],["20-25%","2.0"],["<20%","2.5"]], [LW*0.3,LW*0.7], C_TEAL, 7)) L.append(sp(1.5)) L.append(shdr("2 CLASSIFICATION BY MCV", LW, C_PURPLE)); L.append(sp(0.8)) L.append(mk_table( [[b("MCV"),b("Type"),b("Main Causes")], [red("< 80\nMICRO"),"Microcytic","IDA, Thalassaemia, SA, AoCD"], [blu("80-100\nNORMO"),"Normocytic","Acute blood loss, Haemolysis, AoCD early, CKD"], [grn("> 100\nMACRO"),"Macrocytic","B12/Folate def, Drugs*, Liver dis, Hypothyroid"]], [LW*0.12,LW*0.18,LW*0.70], C_PURPLE, 6.8)) L.append(sp(0.5)) L.append(Paragraph(b("*Megaloblastic drugs: ")+"Anti-cancer, Folate antagonists, Biguanides (Metformin), Anti-epileptics, ART, Nitrous Oxide", tiny)) L.append(sp(1.5)) L.append(shdr("3 MICROCYTIC — DEFECT SITE", LW, C_RED)); L.append(sp(0.8)) L.append(HFlow(["Globin\nTHALASSAEMIA","Heme/Fe\nIDA","Heme/Fe\nSIDEROBLASTIC","Fe trapped\nAoCD"], LW, box_h=22, fsize=6.6, clrs=[C_PURPLE,C_RED,C_ORANGE,C_TEAL])) L.append(sp(1.5)) L.append(shdr("4 HAEMOLYSIS: EV vs IV", LW, C_ORANGE)); L.append(sp(0.8)) L.append(mk_table( [[b("Feature"),b("Extravascular (EV)"),b("Intravascular (IV)")], ["Spherocytes","MORE common","Less"], ["Splenomegaly","YES","Rare"], ["Haptoglobin","Low","Very Low"], ["Haemosiderinuria","No","Yes (chronic)"], ["Bilirubin/Stones","YES","Less"], ["LDH","Elevated","Elevated++"], ["Haemoglobinuria","No","Yes (acute)"]], [LW*0.27,LW*0.365,LW*0.365], C_ORANGE, 6.6)) L.append(sp(0.5)) L.append(Paragraph( b("Leukoerythroblastic picture: ")+"Dacrocytes, Nucleated RBC, Immature WBC, Hepatosplenomegaly. "+ b("Hyperseg PMN: ")+"Single PMN >6 lobes OR >5% PMN with >5 lobes = B12/folate def", tiny)) # RIGHT ─────────────────────────────────────────────────────────────────── R.append(shdr("5 MICROCYTIC DIFFERENTIALS", RW, C_TEAL)); R.append(sp(0.8)) R.append(mk_table( [[b("Lab"),b("IDA"),b("AoCD"),b("Thal Trait"),b("SA")], ["RBC/Retic","Low (MI>13)","Low","High (MI<13)","Low"], ["RDW","HIGH","Normal","Normal","HIGH"], ["Serum Fe","Low","Low","Normal/High","High"], ["Ferritin","LOW","HIGH","Normal","High"], ["sTfR","High","Normal","Normal","Normal"], ["TIBC","High","Low","Normal","Normal"], ["TSAT","<18%",">18%","High","High"], ["sTfR/logFer",">2","<1","-","-"], ["Hepcidin","LOW","HIGH","Normal","-"], ["FEP","High","High","Normal","High"], ["BM Fe","ABSENT","Present","Present","Present+RS"], ["Electrophor","Normal","Normal","ABNORMAL","Normal"], ["Rx","Oral/IV Fe","Rx cause +/-Fe+/-ESA","None specific","Reversible causes +/- Pyridoxine"]], [RW*0.14,RW*0.17,RW*0.17,RW*0.17,RW*0.35], C_TEAL, 6.4)) R.append(sp(0.5)) R.append(Paragraph( b("Oral Fe: ")+"200 mg/day | 6 wks = Hb corrects | 6 months = stores replete. "+ "Poor response (<2g/dL in 3 wks): non-compliance, ongoing bleed, malabsorption, wrong Dx. "+ "Absorption reduced by Ca, PPIs/H2RA, phytates, phosphates, tannates. "+ b("Fe gluconate ")+"12% | "+b("Fe sulphate ")+"20% | "+b("Fe fumarate ")+"35% elemental Fe. "+ b("IV Fe indications: ")+"Intolerance, malabsorption, pre-ESA, CKD-HD, cancer, CHF, IRIDA.", tiny)) R.append(sp(1.5)) R.append(shdr("6 THALASSAEMIA", RW, C_PURPLE)); R.append(sp(0.8)) R.append(mk_table( [[b("Type"),b("Genotype"),b("Clinical")], [pur("Alpha"),"1 deletion","Silent carrier"], ["","2 deletions","Asymptomatic + mild anaemia"], ["","3 deletions","HbH disease"], ["","4 deletions","Death in utero (Hb Barts)"], [pur("Beta"),"B0B0 or B+B+","Thal MAJOR (transfusion-dependent)"], ["","B0B or B+B","Thal MINOR (asymptomatic)"], ["","B0B+ compound het","Thal major/intermedia"], ["","HbSB0 / HbEB0","Thal major phenotype"]], [RW*0.10,RW*0.32,RW*0.58], C_PURPLE, 6.5)) R.append(sp(0.5)) R.append(Paragraph( b("Beta-Thal Major: ")+"Chipmunk facies, Crew-cut XR, Pathologic fractures, HSM (EMH), High-output HF, Gallstones, Fe overload. "+ b("Rx: ")+"PRBC transfusions + Fe chelators +/- splenectomy. "+ b("Chelators: ")+"IV Deferoxamine | Oral Deferiprone TID (BEST for cardiac Fe) | Oral Deferasirox OD (preferred). "+ b("Screen: ")+"Nestroft test. Alpha=AR deletions. Beta=AR point mutations (B+=promoter/splicing; B0=exon stop).", tiny)) R.append(sp(1.5)) R.append(shdr("7 AUTOIMMUNE HAEMOLYTIC ANAEMIA", RW, C_RED)); R.append(sp(0.8)) R.append(mk_table( [[b("Feature"),b("Warm AIHA"),b("Cold Agg. Syn."),b("PCH")], ["Incidence","70%","10-15%","1-2%"], ["Ab","IgG","IgM","IgG biphasic"], ["Complement","NOT activated","Activated","Activated"], ["Temp","37C","<37C","Biphasic"], ["Haemolysis","Mostly EV","Mostly IV","IV"], ["Smear","Spherocytes","Rouleaux/Agg","Spherocytes"], ["Clinical","Fever, jaundice,\nsplenomegaly","Chronic anaemia\n+ acrocyanosis","Post-infection\nacute haemolysis"], ["Etiology","Idiopathic, CTD,\nNeoplasm, Drugs,\nInfections","Monoclonal/\nPolyclonal, Drugs","Idiopathic,\nInfections"], ["Rx","Steroids, IVIg,\nRituximab,\nSplenectomy","Avoid cold\n+ Rituximab\n(STEROIDS FAIL)","Supportive,\nAvoid cold"]], [RW*0.14,RW*0.27,RW*0.27,RW*0.32], C_RED, 6.4)) R.append(sp(0.5)) R.append(Paragraph( b("Drug AIHA: ")+"1. Hapten = beta-lactams (Penicillin) IgG. "+ "2. Immune complex = Quinidine. "+ "3. Drug-independent autoantibody = Methyldopa (warm IgG, persists after drug stopped).", tiny)) elems.append(two_col(L, R, LW, RW, GW)) elems.append(sp(1)) elems.append(HRFlowable(width=PW, color=C_MGRAY, thickness=0.5)) elems.append(Paragraph("Page 1 of 2 | Approach to Anaemia Part 1 | Last-Minute Revision", foot_s)) return elems # ───────────────────────────────────────────────────────────────────────────── def page2(PW): elems = [] elems.append(PageBreak()) LW = PW*0.478; RW = PW*0.478; GW = PW*0.044 tt = Table([[Paragraph( '<font color="white"><b> OSCE PEARLS & AMC-STYLE CASE QUESTIONS — ANAEMIA PART 1</b></font>', ps('ti2g', fontSize=10.5, leading=13))]], colWidths=[PW]) tt.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),C_RED), ('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6),('LEFTPADDING',(0,0),(-1,-1),6)])) elems.append(tt); elems.append(sp(1.5)) L=[]; R=[] # LEFT ──────────────────────────────────────────────────────────────────── def bul(text, fsize=7): return Paragraph(f"<bullet>•</bullet> {text}", ps(f'bl_{text[:8]}', fontSize=fsize, leading=9.5, leftIndent=10, bulletIndent=0)) psections = [ ("IDA PEARLS", C_RED, [ "Koilonychia + pallor + pica = IDA until proven otherwise", "Oral Fe: BLACK STOOLS = normal, NOT false +ve FOBT", "Best absorbed Fe = Ferrous FUMARATE (35% elemental Fe)", "Poor response in 3 wks: non-compliance, bleed, malabsorption, wrong Dx", "IRIDA = TMPRSS6 mutation = Fe-refractory IDA = must use IV Fe", ]), ("AoCD PEARLS", C_ORANGE, [ "Ferritin = acute-phase reactant: HIGH in AoCD even though Fe is low", "Key ratio: sTfR/log Ferritin >2 = IDA, <1 = AoCD", "Hepcidin HIGH in AoCD (blocks ferroportin, traps Fe in macrophages)", "TSAT >18% + low Fe + high Ferritin = AoCD pattern", ]), ("THALASSAEMIA PEARLS", C_PURPLE, [ "Low MCV + NORMAL RDW + HIGH RBC = Thal trait (IDA: HIGH RDW)", "Mentzer Index = MCV/RBC: <13 = Thal, >13 = IDA", "Beta-thal trait: HbA2 >3.5% on electrophoresis", "Deferiprone TID = BEST for cardiac iron removal", "Deferasirox OD = preferred overall chelator", "HSCT = only curative option for Thal Major", ]), ("SIDEROBLASTIC ANAEMIA PEARLS", C_TEAL, [ "Ring sideroblasts on Prussian blue BM stain = pathognomonic", "Reversible causes: ALCOHOL, INH, Lead, Cu deficiency", "INH: inhibits B6 (pyridoxine) = ALAS2 impaired = Rx: Pyridoxine (B6)", "X-linked SA: ALAS2 gene mutation (responds to pyridoxine)", "Acquired: MDS-RARS (SF3B1 mutation)", ]), ("HAEMOLYSIS PEARLS", C_ORANGE, [ "DAT (Coombs) +ve = AIHA. DAT -ve = hereditary, G6PD, TTP, HUS", "G6PD: Heinz bodies + bite cells; trigger = primaquine, dapsone, fava beans", "Warm AIHA (IgG) = steroids work. Cold AIHA (IgM) = STEROIDS FAIL", "Drug AIHA: Penicillin=hapten | Quinidine=immune complex | Methyldopa=autoAb", ]), ("KEY NUMBERS TO MEMORISE", C_GREEN, [ "Oral Fe: 200 mg/day | 6 wks = Hb corrects | 6 months = stores replete", "RI <2 = hypoproliferative | RI >=2 = hyperproliferative", "TSAT <18% = IDA | TSAT >18% = AoCD", "Mentzer Index <13 = Thal | >13 = IDA", "HbA2 >3.5% = beta-thal trait | HbF elevated in Thal Major", "Hyperseg PMN: >6 lobes in 1 PMN OR >5% PMN with >5 lobes = B12/folate def", "MF: >35%=1.0 | 25-35%=1.5 | 20-25%=2.0 | <20%=2.5", ]), ] for sec_title, bg, pts in psections: L.append(shdr(sec_title, LW, bg, fsize=8)); L.append(sp(0.6)) for pt in pts: L.append(bul(pt)) L.append(sp(1.2)) # RIGHT ─────────────────────────────────────────────────────────────────── R.append(shdr("AMC-STYLE CASE QUESTIONS (Q | Answer | Pearl)", RW, C_NAVY)); R.append(sp(1)) cases = [ ("Q1. IDA", "28F, fatigue, menorrhagia. Hb 9.2, MCV 68, RDW 18, Ferritin 4, TIBC high, TSAT 10%, FEP high. Diagnosis and management?", "DX: IDA. RX: Ferrous sulphate 200 mg elemental Fe/day. Investigate source (menorrhagia; exclude GI if >40y or red flags). Recheck Hb in 3 weeks.", "Black stools from oral Fe = NORMAL. Not false +ve FOBT. If <2g/dL rise in 3 wks = problem.", C_LBLUE), ("Q2. AoCD vs IDA", "55M with RA. Hb 10.1, MCV 78, Ferritin 180 (high), Fe low, TIBC 220 (low), TSAT 20%, sTfR normal, CRP high. Diagnosis and best distinguishing test?", "DX: Anaemia of Chronic Disease. Best test: sTfR/log Ferritin ratio (<1 in AoCD vs >2 in IDA). Hepcidin elevated. RX: Treat underlying RA.", "Ferritin >100 in chronic illness = almost always AoCD even if serum Fe appears low.", C_LGREEN), ("Q3. Beta-Thal Major", "3yo Mediterranean child, Hb 6.5, MCV 60, target cells, splenomegaly. Electrophoresis: absent HbA, elevated HbF. Skull XR: crew-cut. Diagnosis and treatment?", "DX: Beta-Thal Major (B0B0). RX: Regular PRBC transfusions + Fe chelation (Deferasirox OD preferred; Deferiprone for cardiac Fe). Curative = Allogeneic HSCT.", "Chipmunk facies = maxillary marrow expansion (EMH). Crew-cut XR = perpendicular trabeculae in skull. Both = classic Thal Major.", C_LYELL), ("Q4. Drug AIHA - Methyldopa", "70F develops haemolytic anaemia on methyldopa. DAT positive. Type and mechanism?", "DX: Drug-independent autoantibody AIHA (Methyldopa). Mechanism: drug induces autoantibody against RBC antigens; persists even AFTER drug stopped. RX: Stop drug +/- steroids.", "Methyldopa = autoantibody (drug-independent). Penicillin = hapten. Quinidine = immune complex. All cause warm (+/-cold) haemolysis.", C_LPURP), ("Q5. Cold AIHA - Why No Steroids?", "45M, anaemia, acrocyanosis in winter, rouleaux on smear, IgM cold agglutinins detected. Why are corticosteroids NOT appropriate?", "DX: Cold Agglutinin Syndrome (Cold AIHA). Steroids are INEFFECTIVE: pathogenic Ab is IgM (not IgG). Steroids reduce IgG, not IgM. RX: Avoid cold + Rituximab.", "Warm AIHA = IgG = steroids work. Cold AIHA = IgM = STEROIDS FAIL. Classic AMC stem trap.", C_LBLUE), ("Q6. SA - INH", "Patient on INH develops microcytic anaemia. BM shows ring sideroblasts. Mechanism and specific treatment?", "DX: INH-induced Sideroblastic Anaemia. Mechanism: INH inhibits pyridoxine (B6), cofactor for ALAS2 (rate-limiting enzyme of haem synthesis). Fe accumulates in mitochondria = ring sideroblasts. RX: Pyridoxine (B6).", "Other reversible SA: alcohol, lead, Cu def. Give pyridoxine prophylactically with INH in high-risk patients.", C_LGREEN), ("Q7. RI Calculation", "Retic 8%, Haematocrit 20%, Normal Hct 45%. Calculate RI. BM response adequate?", "Abs Retic = 8 x (20/45) = 3.56. MF for Hct 20% = 2.5. RI = 3.56 / 2.5 = 1.42. RI <2 = HYPOPROLIFERATIVE = inadequate BM response. Suspect co-existing BM problem.", "Even if cause looks like haemolysis/loss, RI <2 means BM cannot keep up. Investigate Fe, B12, infiltration.", C_LYELL), ] for label, q, a, pearl, bg in cases: q_p = Paragraph(b(label + ": ") + q, ps(f'cqg{label[:5]}', fontSize=7, leading=9.5)) a_p = Paragraph(b("A: ") + a, ps(f'cag{label[:5]}', fontSize=7, leading=9.5)) p_p = Paragraph(b("Pearl: ") + pearl, ps(f'cpg{label[:5]}', fontSize=6.8, leading=9, fontName='Helvetica-BoldOblique', textColor=C_TEAL)) card = Table([[q_p],[a_p],[p_p]], colWidths=[RW]) card.setStyle(TableStyle([ ('BACKGROUND', (0,0),(0,0), bg), ('BACKGROUND', (0,1),(0,1), colors.white), ('BACKGROUND', (0,2),(0,2), C_LGRAY), ('BOX', (0,0),(0,-1), 0.7, C_NAVY), ('LINEBELOW', (0,0),(0,1), 0.3, C_MGRAY), ('TOPPADDING', (0,0),(0,-1), 3), ('BOTTOMPADDING', (0,0),(0,-1), 3), ('LEFTPADDING', (0,0),(0,-1), 5), ('RIGHTPADDING', (0,0),(0,-1), 5), ])) R.append(card); R.append(sp(1.5)) elems.append(two_col(L, R, LW, RW, GW)) elems.append(sp(1)) elems.append(HRFlowable(width=PW, color=C_MGRAY, thickness=0.5)) elems.append(Paragraph("Page 2 of 2 | OSCE Pearls + AMC Cases | Approach to Anaemia Part 1", foot_s)) return elems # ───────────────────────────────────────────────────────────────────────────── def main(): M = 9 * mm PW = W - 2*M doc = SimpleDocTemplate(OUTPUT, pagesize=A4, leftMargin=M, rightMargin=M, topMargin=8*mm, bottomMargin=8*mm, title="Anaemia Revision Notes", author="Orris") elems = page1(PW) + page2(PW) doc.build(elems) print(f"PDF saved: {OUTPUT}") if __name__ == "__main__": main() PYEOF echo "Written"
cd /home/daytona/workspace/anemia-notes && python3 build_notes.py 2>&1
ls -lh /home/daytona/workspace/anemia-notes/Anemia_Revision_Notes.pdf
Anemia Revision Notes
PDF Document · PDF
- Reticulocyte Index flowchart - 5-step horizontal arrow flow from "Lab Retic %" → Absolute Retic → RI → RI<2 (hypoproliferative, red) → RI≥2 (hyperproliferative, green), with the Maturation Factor table
- Classification by MCV - colour-coded table (red/blue/green for micro/normo/macro) with causes listed
- Microcytic defect site - horizontal flow: Globin (Thal) → Heme/Fe (IDA) → Heme/Fe (SA) → Fe trapped (AoCD)
- Haemolysis EV vs IV - compact comparison table with all distinguishing features
- Microcytic differentials mega-table - all 4 types (IDA, AoCD, Thal trait, SA) across 13 lab parameters side by side
- Thalassaemia - alpha deletion ladder + beta genotype table + features + chelator hierarchy
- AIHA - Warm vs Cold vs PCH table + drug AIHA mechanisms
- 6 pearl sections (IDA, AoCD, Thal, SA, Haemolysis, Key Numbers) with bullet traps and high-yield triggers
- 7 AMC-style case questions - each card has: coloured question stem, answer with diagnosis and management, and a "Pearl" line in teal italic with the exam trap
Entire pdf is messed up ...make it better and understandable and send ,e...where u need to jsee flowchart use it
cat > /home/daytona/workspace/anemia-notes/build_v2.py << 'PYEOF' """ Anaemia Revision Notes v2 - Direct canvas drawing for perfect layout. Page 1: Master notes with flowcharts and tables Page 2: OSCE Pearls + AMC Cases """ from reportlab.pdfgen import canvas from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import mm from reportlab.platypus import Table, TableStyle, Paragraph, SimpleDocTemplate, Spacer, PageBreak, HRFlowable from reportlab.lib.styles import ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT from reportlab.platypus.flowables import Flowable W, H = A4 # 595.28 x 841.89 pts # ── Colours ────────────────────────────────────────────────────────── NAVY = colors.HexColor("#1B2A4A") TEAL = colors.HexColor("#117A8B") RED = colors.HexColor("#B03030") PURPLE = colors.HexColor("#5B3080") GREEN = colors.HexColor("#1A6B3A") ORANGE = colors.HexColor("#C96B00") AMBER = colors.HexColor("#E8A000") LGRAY = colors.HexColor("#F5F6FA") MGRAY = colors.HexColor("#C8CDD8") WHITE = colors.white BLACK = colors.black LBLUE = colors.HexColor("#D8EEF7") LGREEN = colors.HexColor("#D8F0E3") LYELL = colors.HexColor("#FDF5DC") LPURP = colors.HexColor("#EDE0F5") LRED = colors.HexColor("#FAEAEA") OUTPUT = "/home/daytona/workspace/anemia-notes/Anemia_Revision_Notes_v2.pdf" # ── Font sizes ──────────────────────────────────────────────────────── F_TITLE = 14 F_SEC = 9 F_BODY = 8 F_SMALL = 7 F_TINY = 6.5 def setup_page(c, page_num, total=2): """White background, subtle border.""" c.setFillColor(WHITE) c.rect(0, 0, W, H, fill=1, stroke=0) def draw_rounded_rect(c, x, y, w, h, r, fill_color, stroke_color=None, stroke_w=0.5): c.setFillColor(fill_color) if stroke_color: c.setStrokeColor(stroke_color) c.setLineWidth(stroke_w) c.roundRect(x, y, w, h, r, fill=1, stroke=1) else: c.roundRect(x, y, w, h, r, fill=1, stroke=0) def draw_text_centered(c, text, x, y, font="Helvetica-Bold", size=8, color=WHITE): c.setFillColor(color) c.setFont(font, size) c.drawCentredString(x, y, text) def draw_text_left(c, text, x, y, font="Helvetica", size=8, color=BLACK): c.setFillColor(color) c.setFont(font, size) c.drawString(x, y, text) def wrap_text_in_box(c, text, x, y, w, h, font="Helvetica", size=7, color=BLACK, center=True): """Draw multi-line text wrapped inside a box. Returns actual height used.""" from reportlab.lib.utils import simpleSplit c.setFillColor(color) c.setFont(font, size) lines = simpleSplit(text, font, size, w - 4) line_h = size * 1.3 total_h = len(lines) * line_h start_y = y + h/2 + total_h/2 - line_h for i, line in enumerate(lines): ly = start_y - i * line_h if center: c.drawCentredString(x + w/2, ly, line) else: c.drawString(x + 3, ly, line) def section_header(c, x, y, w, text, bg=NAVY, text_color=WHITE, height=14, fsize=9): draw_rounded_rect(c, x, y, w, height, 3, bg) c.setFillColor(text_color) c.setFont("Helvetica-Bold", fsize) c.drawString(x + 6, y + height/2 - fsize/2 + 1, text) return y - 4 # ── Arrow flowchart (horizontal) ────────────────────────────────────── def horiz_flow(c, x, y, boxes, total_w, box_h=32, fsize=7.5, gap=12): """Draw horizontal flow chart. boxes = list of (text, bg_color)""" n = len(boxes) box_w = (total_w - gap*(n-1)) / n for i, (text, bg) in enumerate(boxes): bx = x + i*(box_w + gap) # Box draw_rounded_rect(c, bx, y, box_w, box_h, 4, bg, WHITE, 0.5) # Text (split by \n) lines = text.split('\n') lh = fsize * 1.3 total_text_h = len(lines) * lh start_ty = y + box_h/2 + total_text_h/2 - lh + 1 c.setFillColor(WHITE) c.setFont("Helvetica-Bold", fsize) for j, line in enumerate(lines): c.drawCentredString(bx + box_w/2, start_ty - j*lh, line) # Arrow if i < n-1: ax = bx + box_w + 2 ay = y + box_h/2 c.setFillColor(AMBER) c.setStrokeColor(AMBER) c.setLineWidth(1.5) c.line(ax, ay, ax + gap - 5, ay) # arrowhead p = c.beginPath() p.moveTo(ax + gap - 5, ay) p.lineTo(ax + gap - 5 - 5, ay + 3.5) p.lineTo(ax + gap - 5 - 5, ay - 3.5) p.close() c.drawPath(p, fill=1, stroke=0) return y - box_h - 4 def vert_flow(c, x, y, boxes, box_w, box_h=20, fsize=7.5, gap=10): """Draw vertical flow chart. Returns y after last box.""" for i, (text, bg) in enumerate(boxes): draw_rounded_rect(c, x, y, box_w, box_h, 4, bg, WHITE, 0.5) lines = text.split('\n') lh = fsize * 1.25 total_text_h = len(lines) * lh start_ty = y + box_h/2 + total_text_h/2 - lh + 1 c.setFillColor(WHITE) c.setFont("Helvetica-Bold", fsize) for j, line in enumerate(lines): c.drawCentredString(x + box_w/2, start_ty - j*lh, line) if i < len(boxes)-1: ax = x + box_w/2 ay = y c.setFillColor(AMBER) c.setStrokeColor(AMBER) c.setLineWidth(1.5) c.line(ax, ay-1, ax, ay - gap + 3) p = c.beginPath() p.moveTo(ax, ay - gap + 2) p.lineTo(ax - 3.5, ay - gap + 2 + 5) p.lineTo(ax + 3.5, ay - gap + 2 + 5) p.close() c.drawPath(p, fill=1, stroke=0) y = y - box_h - gap return y # ── Simple grid table ───────────────────────────────────────────────── def draw_table(c, x, y, headers, rows, col_widths, row_h=13, hdr_bg=NAVY, alt1=WHITE, alt2=LGRAY, hdr_fsize=7, body_fsize=6.5, max_w=None): """Draw a table. Returns y after table.""" n_cols = len(headers) total_w = sum(col_widths) # Header cx = x c.setFillColor(hdr_bg) c.rect(x, y, total_w, row_h, fill=1, stroke=0) for i, (h, cw) in enumerate(zip(headers, col_widths)): c.setFillColor(WHITE) c.setFont("Helvetica-Bold", hdr_fsize) c.drawCentredString(cx + cw/2, y + row_h/2 - hdr_fsize/2 + 1, h) cx += cw y -= row_h # Rows for ri, row in enumerate(rows): bg = alt1 if ri % 2 == 0 else alt2 c.setFillColor(bg) c.rect(x, y, total_w, row_h, fill=1, stroke=0) cx = x for ci, (cell, cw) in enumerate(zip(row, col_widths)): c.setStrokeColor(MGRAY) c.setLineWidth(0.3) if ci > 0: c.line(cx, y, cx, y + row_h) # text cell_lines = str(cell).split('\n') if len(cell_lines) == 1: c.setFillColor(BLACK) c.setFont("Helvetica", body_fsize) c.drawCentredString(cx + cw/2, y + row_h/2 - body_fsize/2 + 1, str(cell)) else: lh = body_fsize * 1.2 tot = len(cell_lines) * lh sy = y + row_h/2 + tot/2 - lh + 1 c.setFillColor(BLACK) c.setFont("Helvetica", body_fsize) for li, cl in enumerate(cell_lines): c.drawCentredString(cx + cw/2, sy - li*lh, cl) cx += cw # bottom border c.setStrokeColor(MGRAY) c.setLineWidth(0.3) c.line(x, y, x + total_w, y) y -= row_h # outer border c.setStrokeColor(MGRAY) c.setLineWidth(0.6) total_rows = len(rows) + 1 c.rect(x, y, total_w, row_h * total_rows, fill=0, stroke=1) return y - 3 def bullet_list(c, x, y, items, width, fsize=7.5, line_h=11, bullet_color=TEAL, label=None, label_bg=None): """Draw bullet list. Returns y after last item.""" if label: if label_bg: draw_rounded_rect(c, x, y, width, 13, 3, label_bg) c.setFillColor(WHITE if label_bg else NAVY) c.setFont("Helvetica-Bold", fsize + 0.5) c.drawString(x + 5, y + 13/2 - (fsize+0.5)/2 + 1, label) y -= 14 for item in items: # bullet dot c.setFillColor(bullet_color) c.circle(x + 4, y + fsize*0.4, 1.5, fill=1, stroke=0) # text from reportlab.lib.utils import simpleSplit c.setFont("Helvetica", fsize) lines = simpleSplit(item, "Helvetica", fsize, width - 14) for j, line in enumerate(lines): c.setFillColor(BLACK) c.drawString(x + 10, y + (fsize-1)*0.3, line) if j < len(lines)-1: y -= line_h * 0.85 y -= line_h return y def case_card(c, x, y, width, label, q_text, a_text, pearl, bg): """Draw an AMC case card. Returns y after card.""" from reportlab.lib.utils import simpleSplit pad = 5 fsize = 7 lh = fsize * 1.3 # Measure heights q_lines = simpleSplit("Q: " + q_text, "Helvetica", fsize, width - pad*2) a_lines = simpleSplit("A: " + a_text, "Helvetica", fsize, width - pad*2) p_lines = simpleSplit("Pearl: " + pearl, "Helvetica-Oblique", fsize - 0.3, width - pad*2) label_h = 13 q_h = len(q_lines) * lh + 4 a_h = len(a_lines) * lh + 4 p_h = len(p_lines) * (fsize - 0.3) * 1.3 + 4 total_h = label_h + q_h + a_h + p_h # Label bar draw_rounded_rect(c, x, y - label_h, width, label_h, 3, NAVY) c.setFillColor(AMBER) c.setFont("Helvetica-Bold", 8) c.drawString(x + 5, y - label_h + label_h/2 - 4 + 1, label) # Q section qy = y - label_h draw_rounded_rect(c, x, qy - q_h, width, q_h, 0, bg) c.setFillColor(RED) c.setFont("Helvetica-Bold", fsize) c.drawString(x + pad, qy - pad - fsize, "Q:") c.setFont("Helvetica", fsize) c.setFillColor(BLACK) ty = qy - pad - fsize for li, line in enumerate(q_lines): if li == 0: c.drawString(x + pad + 14, ty, line.replace("Q: ", "")) else: c.drawString(x + pad + 4, ty - li * lh, line) # A section ay_start = qy - q_h draw_rounded_rect(c, x, ay_start - a_h, width, a_h, 0, WHITE) c.setFillColor(GREEN) c.setFont("Helvetica-Bold", fsize) c.drawString(x + pad, ay_start - pad - fsize, "A:") c.setFont("Helvetica", fsize) c.setFillColor(BLACK) ty2 = ay_start - pad - fsize for li, line in enumerate(a_lines): if li == 0: c.drawString(x + pad + 14, ty2, line.replace("A: ", "")) else: c.drawString(x + pad + 4, ty2 - li * lh, line) # Pearl section py_start = ay_start - a_h draw_rounded_rect(c, x, py_start - p_h, width, p_h, 0, LGRAY) c.setFillColor(TEAL) c.setFont("Helvetica-Bold", fsize) c.drawString(x + pad, py_start - pad - fsize, "Pearl:") c.setFont("Helvetica-Oblique", fsize - 0.3) c.setFillColor(NAVY) ty3 = py_start - pad - fsize for li, line in enumerate(p_lines): if li == 0: c.drawString(x + pad + 30, ty3, line.replace("Pearl: ", "")) else: c.drawString(x + pad + 4, ty3 - li * (fsize-0.3) * 1.3, line) # Outer border c.setStrokeColor(MGRAY) c.setLineWidth(0.7) c.roundRect(x, y - total_h, width, total_h, 3, fill=0, stroke=1) return y - total_h - 6 # ════════════════════════════════════════════════════════════════════ # PAGE 1 # ════════════════════════════════════════════════════════════════════ def draw_page1(c): ML = 12*mm # left margin MR = 12*mm MT = 15*mm # from top MB = 12*mm PW = W - ML - MR # usable width LW = PW * 0.47 RW = PW * 0.47 GW = PW * 0.06 # ── Page background ────────────────────────────────────────────── c.setFillColor(WHITE) c.rect(0, 0, W, H, fill=1, stroke=0) # ── Title Banner ────────────────────────────────────────────────── title_h = 24 ty = H - MT draw_rounded_rect(c, ML, ty - title_h, PW, title_h, 5, NAVY) c.setFillColor(WHITE) c.setFont("Helvetica-Bold", 13) c.drawString(ML + 10, ty - title_h/2 - 5, "ANAEMIA PART 1") c.setFont("Helvetica", 9) c.setFillColor(AMBER) c.drawString(ML + 105, ty - title_h/2 - 4, "Last-Minute Revision | Approach, Classification, IDA, AoCD, Thalassaemia, AIHA") # Page marker c.setFillColor(MGRAY) c.setFont("Helvetica", 7) c.drawRightString(W - MR, ty - title_h/2 - 4, "1 / 2") cur_y = ty - title_h - 6 # ════ LEFT COLUMN ═════════════════════════════════════════════════ lx = ML ly = cur_y # ── Section 1: RI Calculation ────────────────────────────────── ly = section_header(c, lx, ly, LW, "1. RETICULOCYTE INDEX (RI)", NAVY, height=14, fsize=8.5) ly -= 4 # Horizontal flow: 5 steps ri_boxes = [ ("Lab gives\nRetic %", TEAL), ("Abs Retic =\nRetic% x\nPtHct / 45", TEAL), ("RI =\nAbs Retic\n/ MF", NAVY), ("RI < 2\nHYPO-\nPROLIF.\n(BM fail)", RED), ("RI ≥ 2\nHYPER-\nPROLIF.\n(Haemol.)", GREEN), ] horiz_flow(c, lx, ly - 36, ri_boxes, LW, box_h=36, fsize=6.8, gap=10) ly -= 42 # MF table mf_headers = ["Pt Hct", "Maturation Factor"] mf_rows = [[">35%","1.0"],["25–35%","1.5"],["20–25%","2.0"],["<20%","2.5"]] ly = draw_table(c, lx, ly, mf_headers, mf_rows, [LW*0.35, LW*0.65], row_h=11, hdr_bg=TEAL, hdr_fsize=7, body_fsize=7) ly -= 5 # ── Section 2: Classification ────────────────────────────────── ly = section_header(c, lx, ly, LW, "2. CLASSIFICATION BY MCV", PURPLE, height=14, fsize=8.5) ly -= 4 # Flow: MCV → type mcv_boxes = [ ("MCV < 80\nMICROCYTIC\nIDA · Thal · SA · AoCD", RED), ("MCV 80-100\nNORMOCYTIC\nBlood loss · Haemolysis\nCKD · BM failure", NAVY), ("MCV > 100\nMACROCYTIC\nB12/Folate · Drugs*\nLiver · Hypothyroid", GREEN), ] horiz_flow(c, lx, ly - 40, mcv_boxes, LW, box_h=40, fsize=6.8, gap=8) ly -= 47 c.setFillColor(BLACK) c.setFont("Helvetica", 6.5) c.drawString(lx + 2, ly, "*Megaloblastic drugs: Anti-cancer, Folate antagonists, Metformin, Anti-epileptics, ART, Nitrous Oxide") ly -= 10 # ── Section 3: Microcytic Defect ───────────────────────────── ly = section_header(c, lx, ly, LW, "3. MICROCYTIC — WHERE IS THE DEFECT?", RED, height=14, fsize=8.5) ly -= 4 def_boxes = [ ("GLOBIN\ndefect\n→ Thal", PURPLE), ("HEME\ndefect\n→ IDA", RED), ("HEME\ndefect\n→ SA", ORANGE), ("Fe TRAPPED\nin RE\n→ AoCD", TEAL), ] horiz_flow(c, lx, ly - 32, def_boxes, LW, box_h=32, fsize=7, gap=9) ly -= 38 # ── Section 4: Haemolysis ───────────────────────────────────── ly = section_header(c, lx, ly, LW, "4. HAEMOLYSIS — EV vs IV", ORANGE, height=14, fsize=8.5) ly -= 4 hemo_headers = ["Feature", "EV (Extravascular)", "IV (Intravascular)"] hemo_rows = [ ["Site", "Spleen/liver macrophages", "Inside blood vessels"], ["Spherocytes", "MORE common ↑↑", "Less common"], ["Splenomegaly", "YES", "Rare"], ["Haptoglobin", "Low ↓", "Very Low ↓↓↓"], ["Haemosiderinuria", "No", "YES (chronic)"], ["Haemoglobinuria", "No", "YES (acute)"], ["Bilirubin/Stones", "YES", "Less"], ["LDH", "Elevated ↑", "Elevated ↑↑"], ] ly = draw_table(c, lx, ly, hemo_headers, hemo_rows, [LW*0.3, LW*0.35, LW*0.35], row_h=11, hdr_bg=ORANGE, hdr_fsize=7, body_fsize=6.5) ly -= 3 c.setFillColor(NAVY) c.setFont("Helvetica-Bold", 6.5) c.drawString(lx + 2, ly, "Leukeoerythroblastic picture:") c.setFont("Helvetica", 6.5) c.setFillColor(BLACK) c.drawString(lx + 88, ly, " Dacrocytes, Nucleated RBC, Immature WBC, Hepatosplenomegaly") ly -= 9 c.setFillColor(NAVY) c.setFont("Helvetica-Bold", 6.5) c.drawString(lx + 2, ly, "Hyperseg neutrophils:") c.setFont("Helvetica", 6.5) c.setFillColor(BLACK) c.drawString(lx + 70, ly, " Single PMN >6 lobes OR >5% PMN with >5 lobes = B12/Folate def") ly -= 8 # ════ RIGHT COLUMN ════════════════════════════════════════════════ rx = ML + LW + GW ry = cur_y # ── Section 5: Microcytic Differentials ───────────────────── ry = section_header(c, rx, ry, RW, "5. MICROCYTIC DIFFERENTIALS — IDA vs AoCD vs Thal vs SA", TEAL, height=14, fsize=8) ry -= 4 diff_headers = ["Lab", "IDA", "AoCD", "Thal Trait", "SA"] diff_rows = [ ["RBC / Retic", "Low MI>13", "Low", "High MI<13", "Low"], ["RDW", "HIGH ↑", "Normal", "Normal", "HIGH ↑"], ["Serum Fe", "Low ↓", "Low ↓", "Normal/High", "High ↑"], ["Ferritin", "LOW ↓↓", "HIGH ↑↑", "Normal", "High ↑"], ["sTfR", "High ↑", "Normal", "Normal", "Normal"], ["TIBC", "High ↑", "Low ↓", "Normal", "Normal"], ["TSAT", "<18%", ">18%", "High", "High"], ["sTfR/logFer", ">2", "<1", "—", "—"], ["Hepcidin", "Low ↓", "HIGH ↑↑", "Normal", "—"], ["FEP", "High ↑", "High ↑", "Normal", "High ↑"], ["BM Fe stores", "ABSENT ✗", "Present ✓", "Present ✓", "Present+RS"], ["Electrophor.", "Normal", "Normal", "ABNORMAL", "Normal"], ["Rx", "Oral/IV Fe", "Rx cause\n+/-Fe+/-ESA", "None specific", "Reversible\n+/-Pyridoxine"], ] ry = draw_table(c, rx, ry, diff_headers, diff_rows, [RW*0.145, RW*0.185, RW*0.185, RW*0.185, RW*0.30], row_h=12, hdr_bg=TEAL, hdr_fsize=7, body_fsize=6.5) ry -= 4 # Fe management box draw_rounded_rect(c, rx, ry - 28, RW, 28, 3, LGRAY, MGRAY, 0.5) c.setFillColor(NAVY) c.setFont("Helvetica-Bold", 7) c.drawString(rx + 4, ry - 10, "Fe Management: Oral Fe 200mg/day | 6 wks → Hb corrects | 6 months → stores replete") c.setFont("Helvetica", 6.5) c.setFillColor(BLACK) c.drawString(rx + 4, ry - 18, "IV Fe: intolerance, malabsorption, pre-ESA, CKD-HD, cancer, CHF, IRIDA") c.drawString(rx + 4, ry - 26, "Absorption ↓ by: Ca²⁺, PPIs/H₂RA, phytates, phosphates, tannates | Fumarate=35% Sulphate=20% Gluconate=12%") ry -= 32 # ── Section 6: Thalassaemia ─────────────────────────────────── ry = section_header(c, rx, ry, RW, "6. THALASSAEMIA", PURPLE, height=14, fsize=8.5) ry -= 4 thal_headers = ["Type", "Genotype", "Clinical"] thal_rows = [ ["α-Thal", "1 deletion", "Silent carrier"], ["α-Thal", "2 deletions", "Asymptomatic + mild anaemia"], ["α-Thal", "3 deletions (HbH)", "Moderately severe haemolytic anaemia"], ["α-Thal", "4 deletions (Hb Barts)", "Death in utero"], ["β-Thal", "β°β° or β⁺β⁺", "Thal MAJOR (transfusion-dependent)"], ["β-Thal", "β°β or β⁺β", "Thal MINOR (asymptomatic)"], ["β-Thal", "β°β⁺ (compound het)", "Thal intermedia/major"], ["β-Thal", "HbSβ° / HbEβ°", "Thal major phenotype"], ] ry = draw_table(c, rx, ry, thal_headers, thal_rows, [RW*0.13, RW*0.32, RW*0.55], row_h=11, hdr_bg=PURPLE, hdr_fsize=7, body_fsize=6.5) ry -= 4 draw_rounded_rect(c, rx, ry - 32, RW, 32, 3, LPURP, PURPLE, 0.5) c.setFillColor(PURPLE) c.setFont("Helvetica-Bold", 7) c.drawString(rx + 4, ry - 10, "β-Thal Major Features: Chipmunk facies, Crew-cut skull XR, HSM (EMH), High-output HF, Bilirubin gallstones, Fe overload") c.setFont("Helvetica", 6.5) c.setFillColor(BLACK) c.drawString(rx + 4, ry - 18, "Rx: Regular PRBC transfusions + Fe chelators ± splenectomy Screen: Nestroft test") c.drawString(rx + 4, ry - 26, "Chelators: IV Deferoxamine | Oral Deferiprone TID (BEST cardiac Fe) | Oral Deferasirox OD (preferred overall)") c.setFillColor(RED) c.setFont("Helvetica-Bold", 6.5) c.drawString(rx + 4, ry - 33, "α=AR deletions | β=AR point mutations (β⁺=promoter/splicing | β°=exon stop codon)") ry -= 38 # ── Section 7: AIHA ─────────────────────────────────────────── ry = section_header(c, rx, ry, RW, "7. AUTOIMMUNE HAEMOLYTIC ANAEMIA (AIHA)", RED, height=14, fsize=8.5) ry -= 4 aiha_headers = ["Feature", "Warm AIHA", "Cold Agg. Syn.", "PCH"] aiha_rows = [ ["Incidence", "70%", "10–15%", "1–2%"], ["Antibody", "IgG", "IgM", "IgG (biphasic)"], ["Complement", "NOT activated", "Activated", "Activated"], ["Temp", "37°C", "<37°C", "Biphasic"], ["Haemolysis", "Mostly EV", "Mostly IV", "IV"], ["Smear", "Spherocytes", "Rouleaux/Agg.", "Spherocytes"], ["Etiology", "Idiopathic, CTD,\nNeoplasm, Drugs", "Monoclonal/Polyclonal,\nDrugs", "Idiopathic,\nInfections"], ["Rx", "Steroids, IVIg,\nRituximab, Splenectomy", "Avoid cold\n+ Rituximab\n(STEROIDS FAIL)", "Supportive\n+ Avoid cold"], ] ry = draw_table(c, rx, ry, aiha_headers, aiha_rows, [RW*0.15, RW*0.27, RW*0.27, RW*0.31], row_h=12, hdr_bg=RED, hdr_fsize=7, body_fsize=6.5) ry -= 4 draw_rounded_rect(c, rx, ry - 20, RW, 20, 3, LRED, RED, 0.5) c.setFillColor(RED) c.setFont("Helvetica-Bold", 7) c.drawString(rx + 4, ry - 10, "Drug AIHA mechanisms:") c.setFont("Helvetica", 6.5) c.setFillColor(BLACK) c.drawString(rx + 4, ry - 18, "1. Hapten = Beta-lactams (Penicillin) 2. Immune complex = Quinidine 3. Drug-independent autoAb = Methyldopa") ry -= 25 # Footer c.setFillColor(MGRAY) c.line(ML, MB + 5, W - MR, MB + 5) c.setFillColor(colors.HexColor("#888888")) c.setFont("Helvetica", 6.5) c.drawCentredString(W/2, MB - 2, "Page 1 of 2 | Approach to Anaemia Part 1 | Last-Minute Revision") c.showPage() # ════════════════════════════════════════════════════════════════════ # PAGE 2 — OSCE PEARLS + AMC CASES # ════════════════════════════════════════════════════════════════════ def draw_page2(c): ML = 12*mm MR = 12*mm MT = 15*mm MB = 12*mm PW = W - ML - MR LW = PW * 0.47 RW = PW * 0.47 GW = PW * 0.06 c.setFillColor(WHITE) c.rect(0, 0, W, H, fill=1, stroke=0) # Title title_h = 24 ty = H - MT draw_rounded_rect(c, ML, ty - title_h, PW, title_h, 5, RED) c.setFillColor(WHITE) c.setFont("Helvetica-Bold", 13) c.drawString(ML + 10, ty - title_h/2 - 5, "OSCE PEARLS & AMC CASE QUESTIONS") c.setFont("Helvetica", 9) c.setFillColor(LYELL) c.drawString(ML + 220, ty - title_h/2 - 4, "Anaemia Part 1 | Apply Your Knowledge") c.setFillColor(MGRAY) c.setFont("Helvetica", 7) c.drawRightString(W - MR, ty - title_h/2 - 4, "2 / 2") cur_y = ty - title_h - 6 # ════ LEFT: OSCE PEARLS ══════════════════════════════════════════ lx = ML ly = cur_y pearl_sections = [ ("IDA PEARLS", RED, [ "Koilonychia + pallor + pica = IDA until proven otherwise", "Oral Fe: black stools = NORMAL, does NOT cause false +ve FOBT", "Best absorbed Fe = Ferrous FUMARATE (35% elemental Fe)", "Poor response in 3 wks: non-compliance, bleed, malabsorption, wrong Dx", "IRIDA = TMPRSS6 mutation = Fe-refractory IDA = must use IV Fe", ]), ("AoCD PEARLS", ORANGE, [ "Ferritin = acute-phase reactant: HIGH in AoCD even though Fe is low", "Key ratio: sTfR/log Ferritin >2 = IDA; <1 = AoCD (best distinguisher)", "Hepcidin HIGH in AoCD (blocks ferroportin → Fe trapped in macrophages)", "TSAT >18% + low Fe + high Ferritin = AoCD pattern", "Primary Rx = treat underlying cause", ]), ("THALASSAEMIA PEARLS", PURPLE, [ "Low MCV + NORMAL RDW + HIGH RBC count = Thal trait (IDA has HIGH RDW)", "Mentzer Index = MCV/RBC: <13 = Thal | >13 = IDA", "Beta-thal trait: HbA2 >3.5% on electrophoresis", "Deferiprone TID = BEST for cardiac iron removal", "Deferasirox OD = preferred overall chelator", "HSCT = only CURATIVE option for Thal Major", ]), ("SIDEROBLASTIC ANAEMIA PEARLS", TEAL, [ "Ring sideroblasts on Prussian blue BM biopsy = pathognomonic", "INH: inhibits Pyridoxine (B6) → impairs ALAS2 → Rx = Pyridoxine", "Reversible SA causes: ALCOHOL, INH, Lead poisoning, Cu deficiency", "X-linked SA = ALAS2 gene mutation (responds to pyridoxine)", "All Fe indices elevated (Fe, Ferritin, TSAT) — can mimic haemochromatosis", ]), ("HAEMOLYSIS PEARLS", ORANGE, [ "DAT (Coombs) +ve = AIHA. DAT -ve = hereditary spherocytosis, G6PD, TTP", "G6PD: Heinz bodies + bite cells; triggered by primaquine, dapsone, fava beans", "Warm AIHA (IgG) → steroids work. Cold AIHA (IgM) → STEROIDS FAIL", "Drug AIHA: Penicillin=hapten | Quinidine=immune complex | Methyldopa=autoAb", ]), ("KEY NUMBERS TO MEMORISE", GREEN, [ "Oral Fe: 200 mg/day | 6 wks = Hb corrects | 6 months = stores replete", "RI <2 = hypoproliferative (BM fail) | RI ≥2 = hyperproliferative", "TSAT <18% = IDA | TSAT >18% = AoCD", "Mentzer Index <13 = Thal | >13 = IDA", "HbA2 >3.5% = beta-thal trait | HbF elevated in Thal Major", "Hyperseg PMN: >6 lobes in 1 cell OR >5% cells with >5 lobes = B12/folate", "MF: Hct >35%=1.0 | 25-35%=1.5 | 20-25%=2.0 | <20%=2.5", ]), ] from reportlab.lib.utils import simpleSplit for sec_title, bg, pts in pearl_sections: # Section header draw_rounded_rect(c, lx, ly - 13, LW, 13, 3, bg) c.setFillColor(WHITE) c.setFont("Helvetica-Bold", 8) c.drawString(lx + 5, ly - 13 + 13/2 - 4 + 1, sec_title) ly -= 16 for pt in pts: # Bullet c.setFillColor(bg) c.circle(lx + 5, ly + 3, 2, fill=1, stroke=0) c.setFillColor(BLACK) c.setFont("Helvetica", 7.2) lines = simpleSplit(pt, "Helvetica", 7.2, LW - 14) for j, line in enumerate(lines): c.drawString(lx + 11, ly + 1 - j * 9, line) ly -= (len(lines) * 9 + 2) ly -= 4 # ════ RIGHT: AMC CASES ════════════════════════════════════════════ rx = ML + LW + GW ry = cur_y # Header draw_rounded_rect(c, rx, ry - 14, RW, 14, 3, NAVY) c.setFillColor(WHITE) c.setFont("Helvetica-Bold", 8.5) c.drawString(rx + 5, ry - 14 + 14/2 - 4 + 1, "AMC-STYLE CASE QUESTIONS (Q | Answer | Pearl)") ry -= 18 cases = [ ("Q1 — IDA", "28F, fatigue, menorrhagia. Hb 9.2, MCV 68, RDW 18, Ferritin 4, TIBC high, TSAT 10%, FEP high. Diagnosis and first-line management?", "DX: Iron Deficiency Anaemia. RX: Ferrous sulphate 200mg elemental Fe/day. Investigate source (check GI if >40y or red flags). Recheck Hb in 3 weeks.", "Black stools from oral Fe = NORMAL, not false +ve FOBT. If Hb rise <2g/dL in 3wks → non-compliance, bleed, malabsorption, wrong Dx.", LBLUE), ("Q2 — AoCD vs IDA", "55M with RA. Hb 10.1, MCV 78, Ferritin 180 (high), Fe low, TIBC 220 (low), TSAT 20%, sTfR normal, CRP high. Diagnosis and SINGLE best distinguishing test?", "DX: Anaemia of Chronic Disease. Best test: sTfR/log Ferritin ratio (<1 in AoCD vs >2 in IDA). Hepcidin elevated. Rx: Treat underlying RA.", "Ferritin >100 in chronic illness almost always = AoCD, even if serum Fe appears low. Don't be fooled.", LGREEN), ("Q3 — Beta-Thal Major", "3yo Mediterranean child, Hb 6.5, MCV 60, target cells, splenomegaly. Electrophoresis: absent HbA, elevated HbF. Skull XR: crew-cut. Diagnosis and Rx?", "DX: Beta-Thal Major (B0B0). Rx: Regular PRBC transfusions + Fe chelation. Deferasirox OD = preferred. Deferiprone TID = cardiac Fe. Curative = Allogeneic HSCT.", "Chipmunk facies = maxillary marrow expansion (EMH). Crew-cut XR = perpendicular trabeculae in skull. Both = Thal Major.", LYELL), ("Q4 — Drug AIHA (Methyldopa)", "70F develops haemolytic anaemia on methyldopa. DAT positive. Which type of drug AIHA and what is the mechanism?", "DX: Drug-independent autoantibody AIHA. Mechanism: methyldopa induces a TRUE autoantibody against RBC antigens — persists even AFTER drug is stopped. Rx: Stop drug ± steroids.", "Methyldopa = autoantibody (drug-independent). Penicillin = hapten (drug must be present). Quinidine = immune complex. Classic AMC distinction.", LPURP), ("Q5 — Cold AIHA / Why No Steroids?", "45M, anaemia + acrocyanosis in cold. Rouleaux on smear. IgM cold agglutinins. Why are corticosteroids NOT appropriate treatment?", "DX: Cold Agglutinin Syndrome. Steroids are INEFFECTIVE because pathogenic Ab is IgM — steroids reduce IgG production, not IgM. Rx: Avoid cold + Rituximab (anti-CD20).", "Warm AIHA = IgG = steroids work. Cold AIHA = IgM = STEROIDS FAIL. Classic exam trap.", LBLUE), ("Q6 — SA from INH", "TB patient on INH develops microcytic anaemia. BM biopsy shows ring sideroblasts. Mechanism and specific Rx?", "DX: INH-induced Sideroblastic Anaemia. Mechanism: INH inhibits Pyridoxine (B6) which is cofactor for ALAS2 (rate-limiting enzyme of haem synthesis). Fe accumulates in mitochondria = ring sideroblasts. Rx: Pyridoxine (Vit B6).", "ALAS2 = rate-limiting step of haem synthesis. B6 is its cofactor. Give pyridoxine prophylactically with INH in high-risk patients.", LGREEN), ("Q7 — RI Calculation", "Retic count 8%, Pt Haematocrit 20%, Normal Hct 45%. Calculate RI. Is BM response adequate?", "Abs Retic = 8 x (20/45) = 3.56. MF for Hct 20% = 2.5. RI = 3.56 / 2.5 = 1.42. RI <2 = HYPOPROLIFERATIVE = inadequate BM response despite peripheral cause.", "If cause looks like haemolysis/blood loss but RI <2, always suspect co-existing BM suppression (Fe def, B12 def, infiltration).", LYELL), ] for label, q, a, pearl, bg in cases: # Measure heights q_lines = simpleSplit(q, "Helvetica", 7, RW - 10) a_lines = simpleSplit(a, "Helvetica", 7, RW - 10) p_lines = simpleSplit(pearl, "Helvetica-Oblique", 6.8, RW - 10) lh = 9 label_h = 13 q_h = len(q_lines) * lh + 6 a_h = len(a_lines) * lh + 6 p_h = len(p_lines) * 8.8 + 5 total_h = label_h + q_h + a_h + p_h # Label draw_rounded_rect(c, rx, ry - label_h, RW, label_h, 3, NAVY) c.setFillColor(AMBER) c.setFont("Helvetica-Bold", 8) c.drawString(rx + 5, ry - label_h + 4, label) # Q qy = ry - label_h draw_rounded_rect(c, rx, qy - q_h, RW, q_h, 0, bg) c.setFillColor(RED) c.setFont("Helvetica-Bold", 7) c.drawString(rx + 4, qy - 9, "Q:") c.setFont("Helvetica", 7) c.setFillColor(BLACK) for li, line in enumerate(q_lines): c.drawString(rx + 18, qy - 9 - li * lh, line) # A ay = qy - q_h draw_rounded_rect(c, rx, ay - a_h, RW, a_h, 0, WHITE) c.setFillColor(GREEN) c.setFont("Helvetica-Bold", 7) c.drawString(rx + 4, ay - 9, "A:") c.setFont("Helvetica", 7) c.setFillColor(BLACK) for li, line in enumerate(a_lines): c.drawString(rx + 18, ay - 9 - li * lh, line) # Pearl py = ay - a_h draw_rounded_rect(c, rx, py - p_h, RW, p_h, 0, LGRAY) c.setFillColor(TEAL) c.setFont("Helvetica-Bold", 6.8) c.drawString(rx + 4, py - 8, "Pearl:") c.setFont("Helvetica-Oblique", 6.8) c.setFillColor(NAVY) for li, line in enumerate(p_lines): c.drawString(rx + 34, py - 8 - li * 8.8, line) # Border c.setStrokeColor(MGRAY) c.setLineWidth(0.7) c.roundRect(rx, ry - total_h, RW, total_h, 3, fill=0, stroke=1) ry -= total_h + 6 # Footer c.setStrokeColor(MGRAY) c.setLineWidth(0.5) c.line(ML, MB + 5, W - MR, MB + 5) c.setFillColor(colors.HexColor("#888888")) c.setFont("Helvetica", 6.5) c.drawCentredString(W/2, MB - 2, "Page 2 of 2 | OSCE Pearls + AMC Case Questions | Approach to Anaemia Part 1") c.showPage() # ════════════════════════════════════════════════════════════════════ def main(): c = canvas.Canvas(OUTPUT, pagesize=A4) c.setTitle("Anaemia Revision Notes") draw_page1(c) draw_page2(c) c.save() print(f"Saved: {OUTPUT}") if __name__ == "__main__": main() PYEOF echo "Written OK"
cd /home/daytona/workspace/anemia-notes && python3 build_v2.py 2>&1
ls -lh /home/daytona/workspace/anemia-notes/Anemia_Revision_Notes_v2.pdf && python3 -c " from pypdf import PdfReader r = PdfReader('/home/daytona/workspace/anemia-notes/Anemia_Revision_Notes_v2.pdf') print(f'Pages: {len(r.pages)}') for i, p in enumerate(r.pages): print(f'Page {i+1} size: {p.mediabox.width:.0f} x {p.mediabox.height:.0f}') "
python3 -c " import subprocess result = subprocess.run( ['pdftoppm', '-r', '120', '-l', '1', '-png', '/home/daytona/workspace/anemia-notes/Anemia_Revision_Notes_v2.pdf', '/home/daytona/workspace/anemia-notes/preview'], capture_output=True, text=True ) print(result.stdout, result.stderr) import os files = os.listdir('/home/daytona/workspace/anemia-notes/') print(files) "
python3 -c " # Check right column content widths vs available space W = 595.28 ML = 12*25.4/72 # 12mm in pts MR = 12*25.4/72 MT = 15*25.4/72 MB = 12*25.4/72 ML = 12/25.4*72 # pts MR = 12/25.4*72 print(f'ML/MR in pts: {ML:.1f}') ML = 12*72/25.4 MR = 12*72/25.4 PW = W - ML - MR LW = PW * 0.47 RW = PW * 0.47 GW = PW * 0.06 print(f'W={W:.1f}, ML={ML:.1f}, PW={PW:.1f}, LW={LW:.1f}, RW={RW:.1f}, GW={GW:.1f}') print(f'LW+GW+RW={LW+GW+RW:.1f} should equal PW={PW:.1f}') "
cat > /home/daytona/workspace/anemia-notes/build_v3.py << 'PYEOF' """Anaemia Notes v3 — direct canvas, fixed layout, proper column widths.""" from reportlab.pdfgen import canvas from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import mm from reportlab.lib.utils import simpleSplit W, H = A4 # 595.28 x 841.89 # ── Palette ────────────────────────────────────────────────────────── NAVY = colors.HexColor("#1B2A4A") TEAL = colors.HexColor("#0D7377") RED = colors.HexColor("#AA2B2B") PURPLE = colors.HexColor("#5B2D8E") GREEN = colors.HexColor("#1A6B3A") ORANGE = colors.HexColor("#B55B00") AMBER = colors.HexColor("#D49000") LGRAY = colors.HexColor("#F4F5F8") MGRAY = colors.HexColor("#B8BEC8") WHITE = colors.white BLACK = colors.black LBLUE = colors.HexColor("#D8EEF7") LGREEN = colors.HexColor("#D5EFE2") LYELL = colors.HexColor("#FDF5DC") LPURP = colors.HexColor("#EDE0F5") LRED = colors.HexColor("#FAEAEA") OUTPUT = "/home/daytona/workspace/anemia-notes/Anemia_Revision_Notes_v3.pdf" # ── Layout constants ───────────────────────────────────────────────── ML = 8*mm; MR = 8*mm; MT = 8*mm; MB = 8*mm PW = W - ML - MR # ~511 pts LW = PW*0.485 # ~248 pts RW = PW*0.485 # ~248 pts GW = PW*0.03 # ~15 pts gap def clr(c_obj): return c_obj def sec_bar(cv, x, y, w, text, bg, fsize=8.5, h=14): cv.setFillColor(bg) cv.roundRect(x, y-h, w, h, 3, fill=1, stroke=0) cv.setFillColor(WHITE) cv.setFont("Helvetica-Bold", fsize) cv.drawString(x+6, y-h+h/2-fsize/2+1.5, text) return y-h-3 def hflow(cv, x, y, boxes, w, bh=32, fs=7, gap=10): """Horizontal arrow flowchart. Returns y after.""" n = len(boxes) bw = (w - gap*(n-1)) / n for i,(txt,bg) in enumerate(boxes): bx = x + i*(bw+gap) cv.setFillColor(bg) cv.roundRect(bx, y-bh, bw, bh, 4, fill=1, stroke=0) lines = txt.split('\n') lh = fs*1.25 tot = len(lines)*lh sy = y-bh/2 + tot/2 - fs*0.1 cv.setFillColor(WHITE) cv.setFont("Helvetica-Bold", fs) for j,ln in enumerate(lines): cv.drawCentredString(bx+bw/2, sy-j*lh, ln) if i < n-1: ax = bx+bw+1; ay = y-bh/2 cv.setFillColor(AMBER) cv.setLineWidth(1.2) cv.setStrokeColor(AMBER) cv.line(ax, ay, ax+gap-4, ay) p = cv.beginPath() p.moveTo(ax+gap-3, ay); p.lineTo(ax+gap-3-5, ay+3); p.lineTo(ax+gap-3-5, ay-3); p.close() cv.drawPath(p, fill=1, stroke=0) return y-bh-4 def tbl(cv, x, y, hdrs, rows, cws, rh=12, hbg=NAVY, fs_h=7, fs_b=6.5): """Draw a table. Returns y after table.""" tw = sum(cws) # header cv.setFillColor(hbg) cv.rect(x, y-rh, tw, rh, fill=1, stroke=0) cx = x for h,cw in zip(hdrs,cws): cv.setFillColor(WHITE); cv.setFont("Helvetica-Bold", fs_h) lines = simpleSplit(h,"Helvetica-Bold",fs_h,cw-4) lh2 = fs_h*1.2; tot=len(lines)*lh2 sy = y-rh/2+tot/2-fs_h*0.1 for j,ln in enumerate(lines): cv.drawCentredString(cx+cw/2, sy-j*lh2, ln) cx+=cw y-=rh for ri,row in enumerate(rows): # measure row height max_lines = 1 for cell,cw in zip(row,cws): ls = simpleSplit(str(cell),"Helvetica",fs_b,cw-4) max_lines = max(max_lines,len(ls)) row_h = max(rh, max_lines*fs_b*1.3+4) bg = WHITE if ri%2==0 else LGRAY cv.setFillColor(bg) cv.rect(x, y-row_h, tw, row_h, fill=1, stroke=0) cx = x for ci,(cell,cw) in enumerate(zip(row,cws)): if ci>0: cv.setStrokeColor(MGRAY); cv.setLineWidth(0.3) cv.line(cx, y-row_h, cx, y) lines = simpleSplit(str(cell),"Helvetica",fs_b,cw-4) lh2 = fs_b*1.25; tot=len(lines)*lh2 sy = y-row_h/2+tot/2-fs_b*0.1 cv.setFillColor(BLACK); cv.setFont("Helvetica",fs_b) for j,ln in enumerate(lines): cv.drawCentredString(cx+cw/2, sy-j*lh2, ln) cx+=cw cv.setStrokeColor(MGRAY); cv.setLineWidth(0.3) cv.line(x, y-row_h, x+tw, y-row_h) y-=row_h cv.setStrokeColor(MGRAY); cv.setLineWidth(0.6) # outer border only return y-3 def note_box(cv, x, y, w, lines_data, bg=LGRAY, border=MGRAY): """Small info box. lines_data = list of (bold_part, normal_part) tuples. Returns y after.""" lh = 9; pad = 4 total_h = len(lines_data)*lh + pad*2 cv.setFillColor(bg) cv.roundRect(x, y-total_h, w, total_h, 3, fill=1, stroke=0) cv.setStrokeColor(border); cv.setLineWidth(0.5) cv.roundRect(x, y-total_h, w, total_h, 3, fill=0, stroke=1) ty = y-pad-7 for (bold_part, norm_part) in lines_data: cv.setFont("Helvetica-Bold", 6.8); cv.setFillColor(NAVY) cv.drawString(x+pad, ty, bold_part) bw = cv.stringWidth(bold_part, "Helvetica-Bold", 6.8) cv.setFont("Helvetica", 6.8); cv.setFillColor(BLACK) cv.drawString(x+pad+bw, ty, norm_part) ty -= lh return y-total_h-3 # ════════════════════════════════════════════════════════════════════════ # PAGE 1 # ════════════════════════════════════════════════════════════════════════ def page1(cv): cv.setFillColor(WHITE); cv.rect(0,0,W,H,fill=1,stroke=0) # ── Title ────────────────────────────────────────────────────────── th=22; ty=H-MT cv.setFillColor(NAVY); cv.roundRect(ML,ty-th,PW,th,4,fill=1,stroke=0) cv.setFillColor(WHITE); cv.setFont("Helvetica-Bold",12.5) cv.drawString(ML+8, ty-th/2-5, "ANAEMIA PART 1") cv.setFont("Helvetica",8.5); cv.setFillColor(AMBER) cv.drawString(ML+112, ty-th/2-4.5, "Last-Minute Revision | Approach · Classification · IDA · AoCD · Thalassaemia · AIHA") cv.setFont("Helvetica",7); cv.setFillColor(MGRAY) cv.drawRightString(W-MR, ty-th/2-3, "1/2") cur = ty-th-5 # ════ LEFT ═══════════════════════════════════════════════════════════ lx=ML; ly=cur # 1. RI ly = sec_bar(cv, lx, ly, LW, "1. RETICULOCYTE INDEX (RI)", NAVY) ri = [("Lab Retic%",TEAL),("Abs Retic =\nRetic% x\nPtHct/45",TEAL), ("RI =\nAbsRetic/MF",NAVY),("RI < 2\nHYPO-PROLIF\nBM failure",RED),("RI ≥ 2\nHYPER-PROLIF\nHaemolysis",GREEN)] ly = hflow(cv, lx, ly, ri, LW, bh=33, fs=6.8, gap=9) ly = tbl(cv, lx, ly, ["Pt Hct","Maturation Factor (MF)"], [[">35%","1.0"],["25-35%","1.5"],["20-25%","2.0"],["<20%","2.5"]], [LW*0.38, LW*0.62], rh=11, hbg=TEAL, fs_h=7, fs_b=7) ly -= 4 # 2. Classification ly = sec_bar(cv, lx, ly, LW, "2. CLASSIFICATION BY MCV", PURPLE) mcv = [("MCV < 80\nMICROCYTIC\nIDA · Thal · SA · AoCD",RED), ("MCV 80-100\nNORMOCYTIC\nBlood loss · Haemolysis\nCKD · BM failure",NAVY), ("MCV > 100\nMACROCYTIC\nB12/Folate · Drugs*\nLiver · Hypothyroid",GREEN)] ly = hflow(cv, lx, ly, mcv, LW, bh=40, fs=6.8, gap=8) cv.setFont("Helvetica",6.5); cv.setFillColor(BLACK) cv.drawString(lx+2, ly, "*Megaloblastic drugs: Anti-cancer · Folate antagonists · Metformin · Anti-epileptics · ART · Nitrous Oxide") ly -= 10 # 3. Microcytic defect flow ly = sec_bar(cv, lx, ly, LW, "3. MICROCYTIC — DEFECT SITE", RED) df = [("GLOBIN\ndefect\n→ THAL",PURPLE),("HEME\ndefect\n→ IDA",RED), ("HEME\ndefect\n→ SA",ORANGE),("Fe TRAPPED\nin RE\n→ AoCD",TEAL)] ly = hflow(cv, lx, ly, df, LW, bh=30, fs=7, gap=9) ly -= 2 # 4. Haemolysis ly = sec_bar(cv, lx, ly, LW, "4. HAEMOLYSIS — EV vs IV", ORANGE) ly = tbl(cv, lx, ly, ["Feature","Extravascular (EV)","Intravascular (IV)"], [["Spherocytes","MORE common ↑↑","Less common"], ["Splenomegaly","YES","Rare"], ["Haptoglobin","Low ↓","Very Low ↓↓↓"], ["Haemosiderinuria","No","YES (chronic)"], ["Haemoglobinuria","No","YES (acute)"], ["Bilirubin/Stones","YES","Less"], ["LDH","Elevated ↑","Elevated ↑↑"]], [LW*0.30, LW*0.35, LW*0.35], rh=11, hbg=ORANGE, fs_h=7, fs_b=6.5) cv.setFont("Helvetica-Bold",6.5); cv.setFillColor(NAVY) cv.drawString(lx+2, ly, "Leukoerythroblastic picture:") cv.setFont("Helvetica",6.5); cv.setFillColor(BLACK) cv.drawString(lx+95, ly, " Dacrocytes, Nucleated RBC, Immature WBC, Hepatosplenomegaly") ly -= 9 cv.setFont("Helvetica-Bold",6.5); cv.setFillColor(NAVY) cv.drawString(lx+2, ly, "Hyperseg PMN:") cv.setFont("Helvetica",6.5); cv.setFillColor(BLACK) cv.drawString(lx+54, ly, " Single PMN >6 lobes OR >5% PMN with >5 lobes = B12/Folate deficiency") ly -= 6 # ════ RIGHT ══════════════════════════════════════════════════════════ rx = ML+LW+GW; ry = cur # 5. Differential table ry = sec_bar(cv, rx, ry, RW, "5. MICROCYTIC DIFFERENTIALS: IDA vs AoCD vs Thal vs SA", TEAL, fsize=8) ry = tbl(cv, rx, ry, ["Lab","IDA","AoCD","Thal Trait","SA"], [["RBC/Retic","Low MI>13","Low","High MI<13","Low"], ["RDW","HIGH ↑","Normal","Normal","HIGH ↑"], ["Serum Fe","Low ↓","Low ↓","Normal/High","High ↑"], ["Ferritin","LOW ↓↓","HIGH ↑↑","Normal","High"], ["sTfR","High ↑","Normal","Normal","Normal"], ["TIBC","High ↑","Low ↓","Normal","Normal"], ["TSAT","<18%",">18%","High","High"], ["sTfR/logFer",">2 (IDA)","<1 (AoCD)","—","—"], ["Hepcidin","LOW ↓","HIGH ↑↑","Normal","—"], ["FEP","High ↑","High ↑","Normal","High ↑"], ["BM Fe","ABSENT ✗","Present ✓","Present ✓","Present + RS"], ["Electrophor.","Normal","Normal","ABNORMAL","Normal"], ["Rx","Oral/IV Fe","Rx cause\n+/-Fe+/-ESA","None specific","Reversible\n+/-Pyridoxine"]], [RW*0.145, RW*0.18, RW*0.18, RW*0.18, RW*0.295], rh=12, hbg=TEAL, fs_h=7, fs_b=6.4) ry = note_box(cv, rx, ry, RW, [("Oral Fe: ","200 mg/day | 6 wks = Hb corrects | 6 months = stores replete"), ("IV Fe indications: ","Intolerance, malabsorption, pre-ESA, CKD-HD, cancer, CHF, IRIDA"), ("Absorption reduced by: ","Ca, PPIs/H2RA, phytates, phosphates, tannates"), ("Fe salt elemental content: ","Fumarate=35% Sulphate=20% Gluconate=12%")], bg=LBLUE, border=TEAL) ry -= 2 # 6. Thalassaemia ry = sec_bar(cv, rx, ry, RW, "6. THALASSAEMIA", PURPLE) ry = tbl(cv, rx, ry, ["Type","Genotype","Clinical outcome"], [["α-Thal","1 deletion","Silent carrier"], ["α-Thal","2 deletions","Asymptomatic + mild anaemia"], ["α-Thal","3 deletions (HbH disease)","Moderate haemolytic anaemia"], ["α-Thal","4 deletions (Hb Barts)","Death in utero"], ["β-Thal","β°β° or β+β+","Thal MAJOR (transfusion-dependent)"], ["β-Thal","β°β or β+β","Thal MINOR (asymptomatic)"], ["β-Thal","β°β+ compound het","Thal intermedia/major"], ["β-Thal","HbSβ° / HbEβ°","Thal major phenotype"]], [RW*0.12, RW*0.35, RW*0.53], rh=11, hbg=PURPLE, fs_h=7, fs_b=6.5) ry = note_box(cv, rx, ry, RW, [("β-Thal Major: ","Chipmunk facies, Crew-cut skull XR, HSM (EMH), High-output HF, Bilirubin gallstones, Fe overload"), ("Rx: ","Regular PRBC transfusions + Fe chelators ± splenectomy"), ("Chelators: ","IV Deferoxamine | Oral Deferiprone TID (BEST cardiac Fe) | Oral Deferasirox OD (preferred overall)"), ("Screen: ","Nestroft test | α=AR deletions | β=AR point mutations | HSCT = curative")], bg=LPURP, border=PURPLE) ry -= 2 # 7. AIHA ry = sec_bar(cv, rx, ry, RW, "7. AUTOIMMUNE HAEMOLYTIC ANAEMIA (AIHA)", RED) ry = tbl(cv, rx, ry, ["Feature","Warm AIHA","Cold Agg. Syn.","PCH"], [["Incidence","70%","10-15%","1-2%"], ["Antibody","IgG","IgM","IgG biphasic"], ["Complement","NOT activated","Activated","Activated"], ["Temp","37°C","<37°C","Biphasic"], ["Haemolysis","Mostly EV","Mostly IV","IV"], ["Smear","Spherocytes","Rouleaux/Agg.","Spherocytes"], ["Clinical","Fever, jaundice,\nsplenomegaly","Chronic anaemia\n+ acrocyanosis","Post-infection\nacute haemolysis"], ["Rx","Steroids, IVIg,\nRituximab, Splenectomy","Avoid cold\n+ Rituximab\n(STEROIDS FAIL)","Supportive\n+ Avoid cold"]], [RW*0.145, RW*0.285, RW*0.285, RW*0.285], rh=12, hbg=RED, fs_h=7, fs_b=6.5) ry = note_box(cv, rx, ry, RW, [("Drug AIHA — 3 mechanisms: ",""), ("1. Hapten: ","Beta-lactams (Penicillin) — IgG coats drug-coated RBC"), ("2. Immune complex: ","Quinidine — complement activation, IV haemolysis"), ("3. Drug-independent autoAb: ","Methyldopa — TRUE autoantibody, persists after drug stopped")], bg=LRED, border=RED) # Footer cv.setStrokeColor(MGRAY); cv.setLineWidth(0.5) cv.line(ML, MB+5, W-MR, MB+5) cv.setFont("Helvetica",6.5); cv.setFillColor(colors.HexColor("#888888")) cv.drawCentredString(W/2, MB-2, "Page 1 of 2 | Approach to Anaemia Part 1 | Last-Minute Revision") cv.showPage() # ════════════════════════════════════════════════════════════════════════ # PAGE 2 — OSCE PEARLS + AMC CASES # ════════════════════════════════════════════════════════════════════════ def page2(cv): cv.setFillColor(WHITE); cv.rect(0,0,W,H,fill=1,stroke=0) # Title th=22; ty=H-MT cv.setFillColor(RED); cv.roundRect(ML,ty-th,PW,th,4,fill=1,stroke=0) cv.setFillColor(WHITE); cv.setFont("Helvetica-Bold",12.5) cv.drawString(ML+8, ty-th/2-5, "OSCE PEARLS & AMC CASE QUESTIONS") cv.setFont("Helvetica",8.5); cv.setFillColor(LYELL) cv.drawString(ML+230, ty-th/2-4.5, "Anaemia Part 1 | Apply Your Notes") cv.setFont("Helvetica",7); cv.setFillColor(MGRAY) cv.drawRightString(W-MR, ty-th/2-3, "2/2") cur = ty-th-5 # ════ LEFT: OSCE PEARLS ══════════════════════════════════════════ lx=ML; ly=cur pearl_secs = [ ("IDA PEARLS", RED, [ "Koilonychia + pallor + pica = IDA until proven otherwise", "Oral Fe: BLACK STOOLS = normal, NOT false +ve FOBT", "Best absorbed Fe = Ferrous FUMARATE (35% elemental Fe)", "Poor response in 3 wks: non-compliance, bleed, malabsorption, wrong Dx, mixed deficiency", "IRIDA = TMPRSS6 mutation = Fe-refractory IDA — must use IV Fe", ]), ("AoCD PEARLS", ORANGE, [ "Ferritin = ACUTE-PHASE REACTANT — HIGH in AoCD even though Fe is low", "sTfR/log Ferritin ratio: >2 = IDA | <1 = AoCD (best distinguishing test)", "Hepcidin HIGH in AoCD — blocks ferroportin → Fe trapped in macrophages", "TSAT >18% + low Fe + high Ferritin = AoCD pattern", ]), ("THALASSAEMIA PEARLS", PURPLE, [ "Low MCV + NORMAL RDW + HIGH RBC = Thal trait (IDA has HIGH RDW)", "Mentzer Index = MCV/RBC: <13 = Thal | >13 = IDA", "Beta-thal trait: HbA2 >3.5% on electrophoresis", "Deferiprone TID = BEST for cardiac iron removal", "Deferasirox OD = preferred overall chelator | HSCT = only CURATIVE Rx", ]), ("SIDEROBLASTIC ANAEMIA PEARLS", TEAL, [ "Ring sideroblasts on Prussian blue BM stain = PATHOGNOMONIC", "INH: inhibits Pyridoxine (B6) → impairs ALAS2 → Fe in mitochondria → Rx: Pyridoxine (B6)", "Reversible SA causes: ALCOHOL, INH, Lead poisoning, Copper deficiency", "X-linked SA = ALAS2 gene mutation | Acquired SA = MDS with ring sideroblasts (SF3B1)", ]), ("HAEMOLYSIS PEARLS", ORANGE, [ "DAT (Direct Coombs) +ve = AIHA. DAT -ve = hereditary spherocytosis, G6PD, TTP", "G6PD: Heinz bodies + bite cells; triggered by primaquine, dapsone, fava beans", "Warm AIHA (IgG) = steroids work. Cold AIHA (IgM) = STEROIDS FAIL → Rituximab", "Drug AIHA: Penicillin=hapten | Quinidine=immune complex | Methyldopa=autoantibody", ]), ("KEY NUMBERS TO MEMORISE", GREEN, [ "Oral Fe: 200 mg/day | 6 wks = Hb corrects | 6 months = stores replete", "RI <2 = hypoproliferative (BM failure) | RI ≥2 = hyperproliferative (haemolysis)", "TSAT <18% = IDA | TSAT >18% = AoCD", "Mentzer Index <13 = Thal | >13 = IDA", "HbA2 >3.5% = beta-thal trait | HbF elevated in Thal Major", "Hyperseg PMN: >6 lobes in 1 PMN OR >5% PMN with >5 lobes = B12/Folate def", "MF: Hct >35%=1.0 | 25-35%=1.5 | 20-25%=2.0 | <20%=2.5", ]), ] for stitle, bg, pts in pearl_secs: # bar cv.setFillColor(bg); cv.roundRect(lx, ly-13, LW, 13, 3, fill=1, stroke=0) cv.setFillColor(WHITE); cv.setFont("Helvetica-Bold", 8) cv.drawString(lx+5, ly-9, stitle) ly -= 16 for pt in pts: # dot cv.setFillColor(bg); cv.circle(lx+5, ly+2, 2, fill=1, stroke=0) cv.setFont("Helvetica", 7.2); cv.setFillColor(BLACK) lines = simpleSplit(pt, "Helvetica", 7.2, LW-14) for j, ln in enumerate(lines): cv.drawString(lx+11, ly-(j*9.2), ln) ly -= (len(lines)*9.2 + 2) ly -= 4 # ════ RIGHT: AMC CASES ════════════════════════════════════════════ rx = ML+LW+GW; ry = cur # Bar cv.setFillColor(NAVY); cv.roundRect(rx, ry-13, RW, 13, 3, fill=1, stroke=0) cv.setFillColor(WHITE); cv.setFont("Helvetica-Bold", 8.5) cv.drawString(rx+5, ry-9.5, "AMC-STYLE CASE QUESTIONS (stem | answer | pearl)") ry -= 16 cases = [ ("Q1 — IDA", "28F, fatigue, menorrhagia. Hb 9.2, MCV 68, RDW 18, Ferritin 4, TIBC high, TSAT 10%, FEP high. Dx and first-line management?", "DX: Iron Deficiency Anaemia. RX: Ferrous sulphate 200mg elemental Fe/day. Investigate source. Recheck Hb in 3 wks.", "Black stools from oral Fe = NORMAL. If Hb rise <2g/dL in 3 wks think non-compliance / ongoing bleed / malabsorption.", LBLUE), ("Q2 — AoCD vs IDA", "55M with RA. Hb 10.1, MCV 78, Ferritin 180 (high), Fe low, TIBC low, TSAT 20%, sTfR normal, CRP high. Single best test to distinguish from IDA?", "DX: Anaemia of Chronic Disease. Best test: sTfR/log Ferritin ratio (<1 AoCD vs >2 IDA). Hepcidin elevated. Rx: treat RA.", "Ferritin >100 in chronic illness = almost always AoCD even if serum Fe appears low.", LGREEN), ("Q3 — Beta-Thal Major", "3yo Mediterranean child, Hb 6.5, MCV 60, target cells, splenomegaly. Electrophoresis: absent HbA, elevated HbF. Skull XR: crew-cut. Dx and management?", "DX: β-Thal Major (β0β0). RX: Regular PRBC + Deferasirox OD (or Deferiprone TID for cardiac Fe). Curative = Allogeneic HSCT.", "Chipmunk facies = maxillary marrow expansion (EMH). Crew-cut skull XR = perpendicular trabeculae. Both = Thal Major.", LYELL), ("Q4 — Drug AIHA (Methyldopa)", "70F develops haemolytic anaemia on methyldopa for hypertension. DAT positive. What type of drug AIHA and mechanism?", "DX: Drug-independent autoantibody AIHA. Methyldopa induces TRUE autoantibody against RBC antigens — persists AFTER drug stopped. Rx: Stop drug ± steroids.", "Methyldopa = autoantibody (persists). Penicillin = hapten (drug must be present). Quinidine = immune complex. Classic AMC distinction.", LPURP), ("Q5 — Cold AIHA / Why No Steroids?", "45M, anaemia + acrocyanosis in winter. Rouleaux on smear. IgM cold agglutinins detected. Why are steroids NOT appropriate?", "DX: Cold Agglutinin Syndrome. Steroids reduce IgG not IgM — therefore INEFFECTIVE here. Rx: Avoid cold exposure + Rituximab.", "Warm AIHA = IgG = steroids work. Cold AIHA = IgM = STEROIDS FAIL. Classic exam stem trap.", LBLUE), ("Q6 — Sideroblastic Anaemia (INH)", "TB patient on INH develops microcytic anaemia. BM biopsy: ring sideroblasts. Mechanism and specific treatment?", "DX: INH-induced SA. Mechanism: INH inhibits Pyridoxine (B6) → impairs ALAS2 (rate-limiting haem synthesis step) → Fe in mitochondria = ring sideroblasts. Rx: Pyridoxine (B6).", "ALAS2 = rate-limiting enzyme of haem synthesis, needs B6. Give pyridoxine prophylactically with INH in high-risk patients.", LGREEN), ("Q7 — RI Calculation", "Retic count 8%, Patient Hct 20%, Normal Hct 45%. Calculate RI. Is the BM response adequate?", "Abs Retic = 8 x (20/45) = 3.56. MF for Hct 20% = 2.5. RI = 3.56/2.5 = 1.42. RI <2 = HYPOPROLIFERATIVE = inadequate BM response.", "Even if cause appears to be haemolysis/blood loss, RI <2 means BM cannot respond — look for co-existing Fe/B12 def or infiltration.", LYELL), ] for label, q, a, pearl, bg in cases: q_lines = simpleSplit(q, "Helvetica", 7, RW-14) a_lines = simpleSplit(a, "Helvetica", 7, RW-14) p_lines = simpleSplit(pearl, "Helvetica-Oblique", 6.8, RW-14) lh_q = 9.2; lh_p = 9.0 lbl_h = 13 q_h = max(len(q_lines)*lh_q + 6, 16) a_h = max(len(a_lines)*lh_q + 6, 16) p_h = max(len(p_lines)*lh_p + 5, 14) total = lbl_h + q_h + a_h + p_h # label bar cv.setFillColor(NAVY); cv.roundRect(rx, ry-lbl_h, RW, lbl_h, 3, fill=1, stroke=0) cv.setFillColor(AMBER); cv.setFont("Helvetica-Bold", 8) cv.drawString(rx+5, ry-lbl_h+3.5, label) # Q block qy = ry-lbl_h cv.setFillColor(bg); cv.rect(rx, qy-q_h, RW, q_h, fill=1, stroke=0) cv.setFillColor(RED); cv.setFont("Helvetica-Bold", 7.5) cv.drawString(rx+4, qy-9.5, "Q:") cv.setFont("Helvetica", 7); cv.setFillColor(BLACK) for j, ln in enumerate(q_lines): cv.drawString(rx+18, qy-9.5-j*lh_q, ln) # A block ay = qy-q_h cv.setFillColor(WHITE); cv.rect(rx, ay-a_h, RW, a_h, fill=1, stroke=0) cv.setFillColor(GREEN); cv.setFont("Helvetica-Bold", 7.5) cv.drawString(rx+4, ay-9.5, "A:") cv.setFont("Helvetica", 7); cv.setFillColor(BLACK) for j, ln in enumerate(a_lines): cv.drawString(rx+18, ay-9.5-j*lh_q, ln) # Pearl block py = ay-a_h cv.setFillColor(LGRAY); cv.rect(rx, py-p_h, RW, p_h, fill=1, stroke=0) cv.setFillColor(TEAL); cv.setFont("Helvetica-Bold", 7) cv.drawString(rx+4, py-9, "Pearl:") cv.setFont("Helvetica-Oblique", 6.8); cv.setFillColor(NAVY) for j, ln in enumerate(p_lines): cv.drawString(rx+38, py-9-j*lh_p, ln) # Card border cv.setStrokeColor(MGRAY); cv.setLineWidth(0.8) cv.roundRect(rx, ry-total, RW, total, 3, fill=0, stroke=1) # Separator lines inside card cv.setLineWidth(0.3) cv.line(rx, ry-lbl_h, rx+RW, ry-lbl_h) cv.line(rx, qy-q_h, rx+RW, qy-q_h) cv.line(rx, ay-a_h, rx+RW, ay-a_h) ry -= total+6 # Footer cv.setStrokeColor(MGRAY); cv.setLineWidth(0.5) cv.line(ML, MB+5, W-MR, MB+5) cv.setFont("Helvetica",6.5); cv.setFillColor(colors.HexColor("#888888")) cv.drawCentredString(W/2, MB-2, "Page 2 of 2 | OSCE Pearls + AMC Case Questions | Approach to Anaemia Part 1") cv.showPage() # ════════════════════════════════════════════════════════════════════════ def main(): c = canvas.Canvas(OUTPUT, pagesize=A4) c.setTitle("Anaemia Revision Notes") page1(c) page2(c) c.save() print(f"Saved: {OUTPUT}") if __name__ == "__main__": main() PYEOF echo "Written"
cd /home/daytona/workspace/anemia-notes && python3 build_v3.py 2>&1
python3 -c " import subprocess # Convert both pages subprocess.run(['pdftoppm', '-r', '110', '-png', '/home/daytona/workspace/anemia-notes/Anemia_Revision_Notes_v3.pdf', '/home/daytona/workspace/anemia-notes/prev3'], capture_output=True) import os files = [f for f in os.listdir('/home/daytona/workspace/anemia-notes/') if 'prev3' in f] print(sorted(files)) "
Anemia Revision Notes v3
PDF Document · PDF
- 3 horizontal flowcharts: RI calculation steps, MCV classification (micro/normo/macro), and microcytic defect sites (Thal → IDA → SA → AoCD)
- 5 colour-coded tables: Maturation Factor, EV vs IV haemolysis (with all 7 features), the big 13-row IDA/AoCD/Thal/SA differential table, thalassaemia genotype/clinical table, and AIHA warm/cold/PCH comparison
- Info boxes for Fe management, beta-thal features + chelators, and drug AIHA mechanisms
- Left column: 6 colour-coded pearl sections (IDA, AoCD, Thal, SA, Haemolysis, Key Numbers) - all the "trap" facts and must-know figures
- Right column: 7 AMC-style case cards, each with coloured Q / white A / grey Pearl format
U check the notes...most of the lines u have omitted the ones I have written with hand the flowchart...nothing has been mentioned and most of the lines are overlapping
cd /home/daytona/workspace/attachments/da1db803-171c-4557-b9ed-a9e2e9c93ab0/ && python3 -c " import pdfplumber with pdfplumber.open('Anemia.pdf') as pdf: for i, page in enumerate(pdf.pages): print(f'\n\n======= PAGE {i+1} RAW TEXT =======') print(page.extract_text()) "
Even the flowchart I have hadn't written in the side sof the pages aping with explanation of some wos
python3 -c " import subprocess result = subprocess.run( ['pdftoppm', '-r', '200', '-png', '/home/daytona/workspace/attachments/da1db803-171c-4557-b9ed-a9e2e9c93ab0/Anemia.pdf', '/home/daytona/workspace/anemia-notes/orig'], capture_output=True, text=True ) import os files = sorted([f for f in os.listdir('/home/daytona/workspace/anemia-notes/') if f.startswith('orig')]) print(files) "
# Resize all 4 pages to smaller so they can be read python3 -c " import subprocess for i in range(1,5): subprocess.run(['convert', '-resize', '900x', f'/home/daytona/workspace/anemia-notes/orig-{i}.png', f'/home/daytona/workspace/anemia-notes/orig_sm-{i}.png']) import os files = sorted([f for f in os.listdir('/home/daytona/workspace/anemia-notes/') if 'orig_sm' in f]) print(files) "
python3 -c " from PIL import Image import os for i in range(1,5): src = f'/home/daytona/workspace/anemia-notes/orig-{i}.png' dst = f'/home/daytona/workspace/anemia-notes/orig_sm-{i}.png' img = Image.open(src) # resize to max width 1000 w,h = img.size ratio = 1000/w img2 = img.resize((1000, int(h*ratio)), Image.LANCZOS) img2.save(dst) print(f'Page {i}: {w}x{h} -> {img2.size}') "