Differential Diagnosis by CBC Parameters

ls /home/daytona/workspace/ 2>/dev/null && echo "---" && python3 -c "import repo…

python3 -c "import matplotlib; print(matplotlib.__version__)" && python3 -c "imp…

mkdir -p /home/daytona/workspace/cbc-flowchart

~/cbc-flowchart/generate_flowchart.py

import matplotlib
matplotlib.use('Agg')
import matplotlib.pyplot as plt
import matplotlib.patches as mpatches
from matplotlib.patches import FancyBboxPatch, FancyArrowPatch
from matplotlib.backends.backend_pdf import PdfPages
import textwrap

# ─── COLOR PALETTE ──────────────────────────────────────────────
C = {
    'start':     '#1A3A5C',   # dark navy
    'decision':  '#2E6DA4',   # blue diamond
    'rbc':       '#C0392B',   # red  – RBC branch
    'wbc':       '#1F7A4D',   # green – WBC branch
    'plt':       '#7D3C98',   # purple – Platelet branch
    'micro':     '#E74C3C',   # microcytic
    'normo':     '#E67E22',   # normocytic
    'macro':     '#8E44AD',   # macrocytic
    'dx':        '#F0F4F8',   # light dx box fill
    'dx_border': '#2C3E50',
    'arrow':     '#2C3E50',
    'text_light':'#FFFFFF',
    'text_dark': '#1A1A1A',
    'header_bg': '#1A3A5C',
}

def draw_box(ax, x, y, w, h, text, fc, tc='white', fontsize=7.5, style='round,pad=0.1',
             bold=False, wrap_width=22, lw=1.2, ec=None):
    ec = ec or fc
    box = FancyBboxPatch((x - w/2, y - h/2), w, h,
                         boxstyle=style, linewidth=lw,
                         edgecolor=ec, facecolor=fc, zorder=3)
    ax.add_patch(box)
    wrapped = '\n'.join(textwrap.wrap(text, wrap_width))
    weight = 'bold' if bold else 'normal'
    ax.text(x, y, wrapped, ha='center', va='center', fontsize=fontsize,
            color=tc, fontweight=weight, zorder=4, multialignment='center')

def draw_diamond(ax, x, y, w, h, text, fc, tc='white', fontsize=7):
    dx, dy = w/2, h/2
    diamond = plt.Polygon([[x, y+dy],[x+dx, y],[x, y-dy],[x-dx, y]],
                           closed=True, facecolor=fc, edgecolor='white',
                           linewidth=1.2, zorder=3)
    ax.add_patch(diamond)
    wrapped = '\n'.join(textwrap.wrap(text, 14))
    ax.text(x, y, wrapped, ha='center', va='center', fontsize=fontsize,
            color=tc, fontweight='bold', zorder=4, multialignment='center')

def arrow(ax, x1, y1, x2, y2, label='', lc=C['arrow'], lw=1.5, fs=6.5):
    ax.annotate('', xy=(x2, y2), xytext=(x1, y1),
                arrowprops=dict(arrowstyle='->', color=lc, lw=lw), zorder=2)
    if label:
        mx, my = (x1+x2)/2, (y1+y2)/2
        ax.text(mx+0.05, my, label, fontsize=fs, color=lc, va='center', fontweight='bold')

def bracket_list(ax, x, y, items, color, title='', fontsize=6.8, dot='•'):
    """Draw a bullet list at (x,y) going downward."""
    if title:
        ax.text(x, y, title, fontsize=7, color=color, fontweight='bold', va='top', zorder=4)
        y -= 0.22
    for item in items:
        wrapped = textwrap.wrap(item, 26)
        ax.text(x, y, f'{dot} {wrapped[0]}', fontsize=fontsize, color=C['text_dark'],
                va='top', zorder=4)
        y -= 0.19
        for extra in wrapped[1:]:
            ax.text(x+0.15, y, extra, fontsize=fontsize, color=C['text_dark'], va='top', zorder=4)
            y -= 0.19
    return y


# ══════════════════════════════════════════════════════════════════
# PAGE 1 — RBC / Anemia Flowchart
# ══════════════════════════════════════════════════════════════════
def page_rbc(pdf):
    fig, ax = plt.subplots(figsize=(11, 17))
    ax.set_xlim(0, 11)
    ax.set_ylim(0, 17)
    ax.axis('off')
    fig.patch.set_facecolor('#F7F9FC')

    # ── Header ──────────────────────────────────────────────────
    header = FancyBboxPatch((0, 15.8), 11, 1.1, boxstyle='square',
                            facecolor=C['header_bg'], edgecolor='none')
    ax.add_patch(header)
    ax.text(5.5, 16.4, 'CBC INTERPRETATION — RBC / ANEMIA FLOWCHART',
            ha='center', va='center', fontsize=13, color='white',
            fontweight='bold')
    ax.text(5.5, 16.05, 'Page 1 of 3  |  Orris Clinical Reference',
            ha='center', va='center', fontsize=8, color='#AED6F1')

    # ── Start ────────────────────────────────────────────────────
    draw_box(ax, 5.5, 15.2, 4.0, 0.55, 'CHECK HEMOGLOBIN / HEMATOCRIT',
             C['start'], fontsize=9, bold=True, wrap_width=40)

    arrow(ax, 5.5, 14.93, 5.5, 14.45)

    # ── Decision: Anemia? ────────────────────────────────────────
    draw_diamond(ax, 5.5, 14.1, 3.2, 0.7,
                 'Anemia?\n(Hgb <13 M / <12 F)', C['decision'])
    ax.text(8.2, 14.1, 'No →  Normal / Polycythemia',
            fontsize=7, color=C['wbc'], va='center', style='italic')
    arrow(ax, 5.5, 13.75, 5.5, 13.2)
    ax.text(5.65, 13.47, 'Yes', fontsize=7, color=C['rbc'], fontweight='bold')

    # ── Step: Reticulocyte ───────────────────────────────────────
    draw_box(ax, 5.5, 12.95, 5.5, 0.5,
             'Check Reticulocyte Count + MCV + Peripheral Blood Smear',
             '#2C3E50', fontsize=8, bold=False, wrap_width=50)
    arrow(ax, 5.5, 12.7, 5.5, 12.15)

    # ── Decision: Reticulocyte ────────────────────────────────────
    draw_diamond(ax, 5.5, 11.8, 3.2, 0.65,
                 'Reticulocyte\nIndex > 2%?', C['decision'])

    # YES → right
    arrow(ax, 7.1, 11.8, 8.8, 11.8, 'Yes')
    draw_box(ax, 9.6, 11.8, 2.3, 0.55,
             'HEMOLYTIC or\nBLOOD LOSS\nAnemia',
             C['rbc'], fontsize=7.5, bold=True, wrap_width=18)
    # Sub-list
    items_hemolytic = ['Autoimmune hemolytic\nanemia (AIHA)',
                       'Hereditary spherocytosis',
                       'G6PD deficiency',
                       'Sickle cell disease',
                       'TTP / HUS',
                       'Acute blood loss',
                       'Malaria']
    y0 = 11.42
    for it in items_hemolytic:
        ax.text(8.55, y0, f'• {it}', fontsize=5.8, color=C['text_dark'], va='top')
        y0 -= 0.19

    # NO → down
    arrow(ax, 5.5, 11.47, 5.5, 10.9, 'No ↓')

    # ── MCV Classification ───────────────────────────────────────
    draw_box(ax, 5.5, 10.65, 4.5, 0.5, 'HYPOPROLIFERATIVE — Classify by MCV',
             '#2C3E50', fontsize=8.5, bold=True, wrap_width=40)
    arrow(ax, 5.5, 10.4, 5.5, 9.9)

    draw_diamond(ax, 5.5, 9.55, 3.6, 0.7, 'MCV Value?', C['decision'])

    # ── Three branches from MCV ─────────────────────────────────
    # LEFT: Microcytic <80
    arrow(ax, 3.7, 9.55, 1.8, 9.55)
    ax.text(2.4, 9.65, '<80 fL', fontsize=7, color=C['micro'], fontweight='bold')
    draw_box(ax, 1.2, 9.55, 2.0, 0.5, 'MICROCYTIC\nAnemia',
             C['micro'], fontsize=8, bold=True, wrap_width=15)
    arrow(ax, 1.2, 9.3, 1.2, 8.55)

    micro_items = [
        ('Iron Deficiency Anemia\n(most common)', '#C0392B'),
        ('Thalassemia\n(α or β)', '#922B21'),
        ('Anemia of Chronic Disease\n(can be normocytic)', '#A93226'),
        ('Sideroblastic Anemia', '#7B241C'),
        ('Lead Poisoning', '#641E16'),
    ]
    y0 = 8.45
    for txt, col in micro_items:
        wrapped = textwrap.wrap(txt, 20)
        draw_box(ax, 1.2, y0, 2.0, 0.38, wrapped[0] + (' ...' if len(wrapped)>1 else ''),
                 col, tc='white', fontsize=6.5, bold=False, wrap_width=22)
        arrow(ax, 1.2, y0 - 0.19, 1.2, y0 - 0.42)
        y0 -= 0.6

    # Center note for microcytic
    ax.text(1.2, 5.3, 'Key next test:\nSerum Ferritin\n<30 ng/mL → IDA',
            fontsize=6.5, ha='center', va='top', color='#7B241C',
            bbox=dict(boxstyle='round,pad=0.3', fc='#FADBD8', ec='#C0392B', lw=1))

    # CENTER: Normocytic 80-100
    arrow(ax, 5.5, 9.2, 5.5, 8.55)
    ax.text(5.65, 8.87, '80–100 fL', fontsize=7, color=C['normo'], fontweight='bold')
    draw_box(ax, 5.5, 8.3, 2.0, 0.5, 'NORMOCYTIC\nAnemia',
             C['normo'], fontsize=8, bold=True, wrap_width=15)
    arrow(ax, 5.5, 8.05, 5.5, 7.5)
    draw_box(ax, 5.5, 7.3, 2.8, 0.45,
             'Check: Renal function, TSH, LFTs\nBone marrow, Peripheral smear',
             '#D35400', tc='white', fontsize=6.5, wrap_width=32)

    normo_items = [
        ('Aplastic Anemia', '#E67E22'),
        ('Anemia of CKD / Renal Failure', '#CA6F1E'),
        ('Anemia of Chronic Disease', '#B7770D'),
        ('Hypothyroidism', '#9A7D0A'),
        ('Myelofibrosis', '#7D6608'),
        ('Myelophthisic Anemia', '#6E6B0D'),
        ('Acute Blood Loss (early)', '#5B4A07'),
    ]
    y0 = 6.85
    for txt, col in normo_items:
        draw_box(ax, 5.5, y0, 2.5, 0.35, txt, col, tc='white', fontsize=6.3, wrap_width=24)
        if y0 > 4.5:
            arrow(ax, 5.5, y0 - 0.18, 5.5, y0 - 0.38)
        y0 -= 0.55

    # RIGHT: Macrocytic >100
    arrow(ax, 7.3, 9.55, 9.0, 9.55)
    ax.text(7.9, 9.65, '>100 fL', fontsize=7, color=C['macro'], fontweight='bold')
    draw_box(ax, 9.7, 9.55, 2.0, 0.5, 'MACROCYTIC\nAnemia',
             C['macro'], fontsize=8, bold=True, wrap_width=15)
    arrow(ax, 9.7, 9.3, 9.7, 8.55)
    draw_box(ax, 9.7, 8.3, 2.2, 0.45,
             'Check: B12, Folate,\nLFTs, TSH, Smear',
             '#6C3483', tc='white', fontsize=6.5, wrap_width=22)

    macro_items = [
        ('Vitamin B12 Deficiency', '#7D3C98'),
        ('Folate Deficiency', '#6C3483'),
        ('Liver Disease', '#5B2C6F'),
        ('Hypothyroidism', '#4A235A'),
        ('Myelodysplastic Syndrome', '#3B1A47'),
        ('Drugs (MTX, Hydroxyurea)', '#2C1236'),
    ]
    y0 = 7.85
    for txt, col in macro_items:
        draw_box(ax, 9.7, y0, 2.2, 0.36, txt, col, tc='white', fontsize=6.3, wrap_width=22)
        if y0 > 5.4:
            arrow(ax, 9.7, y0 - 0.18, 9.7, y0 - 0.38)
        y0 -= 0.55

    # ── Legend ───────────────────────────────────────────────────
    legend_items = [
        (C['start'], 'Start/Process'),
        (C['decision'], 'Decision'),
        (C['rbc'], 'Hemolytic'),
        (C['micro'], 'Microcytic'),
        (C['normo'], 'Normocytic'),
        (C['macro'], 'Macrocytic'),
    ]
    lx, ly = 0.3, 2.0
    ax.text(lx, ly + 0.25, 'LEGEND', fontsize=7, fontweight='bold', color=C['text_dark'])
    for i, (col, label) in enumerate(legend_items):
        rect = FancyBboxPatch((lx, ly - i*0.28 - 0.1), 0.22, 0.18,
                              boxstyle='round,pad=0.02', facecolor=col, edgecolor='none')
        ax.add_patch(rect)
        ax.text(lx + 0.30, ly - i*0.28 + 0.0, label, fontsize=6.5, color=C['text_dark'], va='center')

    # Footer
    ax.text(5.5, 0.18, 'Orris CBC Flowchart  |  Based on: Textbook of Family Medicine 9e, Rosen\'s Emergency Medicine 9e, Goldman-Cecil Medicine',
            ha='center', fontsize=6, color='#7F8C8D', style='italic')

    plt.tight_layout(pad=0)
    pdf.savefig(fig, bbox_inches='tight', dpi=200)
    plt.close(fig)


# ══════════════════════════════════════════════════════════════════
# PAGE 2 — WBC Flowchart
# ══════════════════════════════════════════════════════════════════
def page_wbc(pdf):
    fig, ax = plt.subplots(figsize=(11, 17))
    ax.set_xlim(0, 11)
    ax.set_ylim(0, 17)
    ax.axis('off')
    fig.patch.set_facecolor('#F7F9FC')

    # Header
    header = FancyBboxPatch((0, 15.8), 11, 1.1, boxstyle='square',
                            facecolor='#1F4E2E', edgecolor='none')
    ax.add_patch(header)
    ax.text(5.5, 16.4, 'CBC INTERPRETATION — WHITE BLOOD CELL (WBC) FLOWCHART',
            ha='center', va='center', fontsize=13, color='white', fontweight='bold')
    ax.text(5.5, 16.05, 'Page 2 of 3  |  Orris Clinical Reference',
            ha='center', va='center', fontsize=8, color='#A9DFBF')

    draw_box(ax, 5.5, 15.2, 4.5, 0.55, 'CHECK TOTAL WBC COUNT',
             '#1F4E2E', fontsize=9, bold=True, wrap_width=40)
    arrow(ax, 5.5, 14.93, 5.5, 14.3)

    draw_diamond(ax, 5.5, 13.95, 4.2, 0.7,
                 'WBC Count (normal 4–11 × 10³/μL)?', '#2E6DA4', fontsize=7.5)

    # ── HIGH branch ──────────────────────────────────────────────
    arrow(ax, 7.6, 13.95, 9.5, 13.95)
    ax.text(8.2, 14.1, '↑ HIGH', fontsize=8, color='#C0392B', fontweight='bold')
    draw_box(ax, 10.2, 13.95, 1.3, 0.5, 'LEUKO-\nCYTOSIS',
             '#C0392B', fontsize=8, bold=True)
    arrow(ax, 10.2, 13.7, 10.2, 13.1)
    draw_diamond(ax, 10.2, 12.75, 1.5, 0.6, 'Which\ncell?', '#922B21', fontsize=7)

    high_cells = [
        (10.2, 12.1, 'Neutrophilia', '#C0392B',
         ['Bacterial infection', 'CML', 'Steroids/G-CSF', 'Rheumatic disease',
          'Trauma/MI', 'Pregnancy', 'Neoplasia']),
        (10.2, 10.3, 'Eosinophilia', '#E67E22',
         ['Parasitic infection', 'Allergic disease', 'Asthma/Atopy',
          'Myeloproliferative', 'Drug reaction', 'IBD']),
        (10.2, 8.5, 'Basophilia', '#8E44AD',
         ['CML (hallmark)', 'Polycythemia vera', 'Allergic reactions',
          'Hypothyroidism', 'Myeloid metaplasia']),
        (10.2, 6.7, 'Monocytosis', '#1F7A4D',
         ['TB / SBE', 'Sarcoidosis', 'Malignancy', 'GI disorders',
          'Marrow recovery', 'Drug reaction']),
        (10.2, 4.9, 'Lymphocytosis', '#2E6DA4',
         ['EBV / CMV', 'Hepatitis', 'CLL', 'Pertussis',
          'Other viral infections', 'Lymphoproliferative']),
    ]
    for bx, by, label, col, items in high_cells:
        arrow(ax, bx, by + 0.55, bx, by + 0.25)
        draw_box(ax, bx, by + 0.0, 1.4, 0.4, label, col, fontsize=7, bold=True, wrap_width=16)
        y0 = by - 0.22
        for it in items:
            ax.text(9.45, y0, f'• {it}', fontsize=5.8, color=C['text_dark'], va='top')
            y0 -= 0.18

    # ── LOW branch ───────────────────────────────────────────────
    arrow(ax, 3.4, 13.95, 1.5, 13.95)
    ax.text(2.0, 14.1, '↓ LOW', fontsize=8, color='#2980B9', fontweight='bold')
    draw_box(ax, 0.8, 13.95, 1.3, 0.5, 'LEUKO-\nPENIA',
             '#2980B9', fontsize=8, bold=True)
    arrow(ax, 0.8, 13.7, 0.8, 13.1)
    draw_diamond(ax, 0.8, 12.75, 1.5, 0.6, 'Which\ncell?', '#1A5276', fontsize=7)

    low_cells = [
        (0.8, 12.1, 'Neutropenia', '#2980B9',
         ['Viral infections', 'Drug reaction\n(chemo, clozapine)', 'Aplastic anemia',
          'Autoimmune (SLE)', 'Overwhelming\nbacterial sepsis', 'Radiation']),
        (0.8, 10.0, 'Lymphopenia', '#1F618D',
         ['HIV/AIDS', 'Corticosteroids', 'Chemotherapy', 'Radiation',
          'Advanced lymphoma', 'Anorexia nervosa']),
        (0.8, 8.1, 'Eosinopenia', '#154360',
         ['Acute physical stress', 'Cushing syndrome', 'Corticosteroids',
          'Acute inflammation']),
        (0.8, 6.5, 'Monocytopenia', '#0B2545',
         ['Hairy cell leukemia', 'Onset steroid therapy']),
        (0.8, 5.3, 'Basopenia', '#17202A',
         ['Acute stress', 'Hyperthyroidism', 'Glucocorticoids']),
    ]
    for bx, by, label, col, items in low_cells:
        arrow(ax, bx, by + 0.55, bx, by + 0.25)
        draw_box(ax, bx, by + 0.0, 1.4, 0.4, label, col, fontsize=7, bold=True, wrap_width=16)
        y0 = by - 0.22
        for it in items:
            lines = textwrap.wrap(it, 18)
            for ln in lines:
                ax.text(0.1, y0, f'• {ln}', fontsize=5.8, color=C['text_dark'], va='top')
                y0 -= 0.18

    # ── Normal note ───────────────────────────────────────────────
    arrow(ax, 5.5, 13.6, 5.5, 12.85)
    ax.text(5.65, 13.22, 'Normal', fontsize=7, color='#1F7A4D', fontweight='bold')
    draw_box(ax, 5.5, 12.6, 3.8, 0.45,
             'Normal WBC — Check differential for\nrelative abnormalities; clinical correlation',
             '#1F7A4D', fontsize=7, wrap_width=40)

    # Key note box
    note_box = FancyBboxPatch((3.5, 3.5), 4.5, 2.2, boxstyle='round,pad=0.15',
                              facecolor='#EBF5FB', edgecolor='#2E6DA4', lw=1.5)
    ax.add_patch(note_box)
    ax.text(5.75, 5.55, '⚠  KEY CLINICAL NOTES', fontsize=8, fontweight='bold',
            color='#1A5276', ha='center', va='center')
    notes = [
        '• Toxic granulation + vacuolation of neutrophils → sepsis',
        '• Blasts on smear → acute leukemia (urgent)',
        '• Hyperleukocytosis (>100k) → leukostasis emergency',
        '• "Left shift" (band neutrophils) → bacterial infection',
        '• Pelger-Huët anomaly → MDS or drug effect',
        '• Döhle bodies → infection, inflammation, MYH9 disorder',
    ]
    y0 = 5.25
    for n in notes:
        ax.text(3.7, y0, n, fontsize=6.5, color='#1A3A5C', va='top')
        y0 -= 0.28

    ax.text(5.5, 0.18, 'Orris CBC Flowchart  |  Based on: Textbook of Family Medicine 9e, Goldman-Cecil Medicine, Rosen\'s Emergency Medicine 9e',
            ha='center', fontsize=6, color='#7F8C8D', style='italic')

    plt.tight_layout(pad=0)
    pdf.savefig(fig, bbox_inches='tight', dpi=200)
    plt.close(fig)


# ══════════════════════════════════════════════════════════════════
# PAGE 3 — Platelet Flowchart
# ══════════════════════════════════════════════════════════════════
def page_platelet(pdf):
    fig, ax = plt.subplots(figsize=(11, 17))
    ax.set_xlim(0, 11)
    ax.set_ylim(0, 17)
    ax.axis('off')
    fig.patch.set_facecolor('#F7F9FC')

    # Header
    header = FancyBboxPatch((0, 15.8), 11, 1.1, boxstyle='square',
                            facecolor='#4A235A', edgecolor='none')
    ax.add_patch(header)
    ax.text(5.5, 16.4, 'CBC INTERPRETATION — PLATELET FLOWCHART',
            ha='center', va='center', fontsize=13, color='white', fontweight='bold')
    ax.text(5.5, 16.05, 'Page 3 of 3  |  Orris Clinical Reference',
            ha='center', va='center', fontsize=8, color='#D7BDE2')

    draw_box(ax, 5.5, 15.2, 4.5, 0.55, 'CHECK PLATELET COUNT\n(Normal: 150–400 × 10³/μL)',
             '#4A235A', fontsize=9, bold=True, wrap_width=40)
    arrow(ax, 5.5, 14.93, 5.5, 14.3)

    draw_diamond(ax, 5.5, 13.95, 4.0, 0.7, 'Platelet Count?', '#7D3C98')

    # ── LOW (Thrombocytopenia) ────────────────────────────────────
    arrow(ax, 3.5, 13.95, 1.4, 13.95)
    ax.text(1.8, 14.12, '↓ <150k', fontsize=8, color='#C0392B', fontweight='bold')
    draw_box(ax, 0.7, 13.95, 1.2, 0.55, 'THROMBO-\nCYTOPENIA', '#C0392B', fontsize=8, bold=True)
    arrow(ax, 0.7, 13.68, 0.7, 12.95)

    # FIRST: rule out pseudo
    draw_box(ax, 0.7, 12.7, 2.6, 0.45,
             'Step 1: Peripheral Smear — Rule out\nPseudothrombocytopenia (EDTA clumping)',
             '#7F8C8D', tc='white', fontsize=6.8, wrap_width=30)
    arrow(ax, 0.7, 12.47, 0.7, 11.85)

    draw_diamond(ax, 0.7, 11.5, 2.6, 0.65, 'Mechanism?', '#922B21', fontsize=8)

    mech_cols = [
        (0.25, 10.6, 'Decreased\nProduction', '#C0392B',
         ['Aplastic anemia', 'Chemotherapy / radiation', 'Vit B12 / folate deficiency',
          'Myelodysplastic syndrome', 'Marrow infiltration', 'Drugs (thiazides)', 'SLE']),
        (3.3, 10.6, 'Increased\nDestruction', '#8E44AD',
         ['ITP (immune)', 'Heparin-induced (HIT)', 'Drug-induced (quinine,\nsulfonamides)',
          'TTP / HUS', 'DIC', 'Neonatal alloimmune', 'Preeclampsia / HELLP']),
        (-2.1, 10.6, 'Sequestration/\nDilutional', '#2980B9',
         ['Hypersplenism\n(cirrhosis, storage dis.)', 'Massive transfusion', 'Pregnancy (gestational)']),
    ]
    # Draw 3 sub-branches
    positions = [(0.7, 10.85), (3.3, 10.85)]  # left & right of diamond
    arrow(ax, 0.7, 11.18, 0.7, 10.95)
    arrow(ax, 1.95, 11.5, 3.3, 11.5)
    ax.text(2.4, 11.62, 'Immune/\nConsumption', fontsize=6, color='#8E44AD', ha='center')
    arrow(ax, 3.3, 11.18, 3.3, 10.95)

    arrow(ax, -0.55, 11.5, -1.4, 11.5)
    ax.text(-1.1, 11.62, 'Sequestration', fontsize=5.8, color='#2980B9', ha='center')
    # For sequestration: offset left of page — instead use bottom placement
    # Reposition: place all 3 vertically
    # 3 columns: x=1.2, 5.0, 9.0
    col_xs = [1.1, 5.0, 9.0]
    mech_data = [
        ('↓ Production', '#C0392B',
         ['Aplastic anemia', 'Chemotherapy / radiation', 'Vit B12 / folate deficiency',
          'Myelodysplastic syndrome', 'Marrow infiltration (lymphoma, mets)',
          'Drugs (thiazides, linezolid)', 'SLE']),
        ('Consumption /\nImmune Destruction', '#8E44AD',
         ['ITP', 'Heparin-induced (HIT)', 'Drug-induced\n(quinine, sulfonamides)',
          'TTP / HUS (MAHA)', 'DIC', 'Neonatal alloimmune TP', 'Preeclampsia / HELLP']),
        ('Sequestration /\nDilutional', '#2980B9',
         ['Hypersplenism (cirrhosis)', 'Portal hypertension',
          'Storage diseases\n(Gaucher, Niemann-Pick)',
          'Massive transfusion', 'Gestational thrombocytopenia']),
    ]

    # Redraw mechanism section cleanly
    ax.cla()
    ax.set_xlim(0, 11)
    ax.set_ylim(0, 17)
    ax.axis('off')
    fig.patch.set_facecolor('#F7F9FC')

    # Re-header
    header = FancyBboxPatch((0, 15.8), 11, 1.1, boxstyle='square', facecolor='#4A235A', edgecolor='none')
    ax.add_patch(header)
    ax.text(5.5, 16.4, 'CBC INTERPRETATION — PLATELET FLOWCHART',
            ha='center', va='center', fontsize=13, color='white', fontweight='bold')
    ax.text(5.5, 16.05, 'Page 3 of 3  |  Orris Clinical Reference',
            ha='center', va='center', fontsize=8, color='#D7BDE2')

    draw_box(ax, 5.5, 15.2, 4.5, 0.55, 'CHECK PLATELET COUNT\n(Normal: 150–400 × 10³/μL)',
             '#4A235A', fontsize=9, bold=True, wrap_width=40)
    arrow(ax, 5.5, 14.93, 5.5, 14.3)
    draw_diamond(ax, 5.5, 13.95, 4.0, 0.7, 'Platelet Count?', '#7D3C98')

    # ── HIGH (Thrombocytosis) ─────────────────────────────────────
    arrow(ax, 7.5, 13.95, 9.5, 13.95)
    ax.text(8.0, 14.12, '↑ >400k', fontsize=8, color='#1F7A4D', fontweight='bold')
    draw_box(ax, 10.2, 13.95, 1.3, 0.55, 'THROMBO-\nCYTOSIS', '#1F7A4D', fontsize=8, bold=True)
    arrow(ax, 10.2, 13.68, 10.2, 13.0)
    draw_diamond(ax, 10.2, 12.65, 1.5, 0.6, 'Primary\nor\nReactive?', '#1F4E2E', fontsize=7)

    arrow(ax, 10.2, 12.35, 10.2, 11.75)
    draw_box(ax, 10.2, 11.5, 2.0, 0.45, 'REACTIVE\n(Secondary)', '#27AE60', fontsize=7.5, bold=True)
    react_items = ['Iron deficiency', 'Acute blood loss', 'Post-splenectomy', 'Inflammatory disease (RA, IBD)',
                   'Malignancy', 'Infection/surgery', 'Count rarely >1,000k/μL']
    y0 = 11.22
    for it in react_items:
        ax.text(9.2, y0, f'• {it}', fontsize=6, color=C['text_dark'], va='top')
        y0 -= 0.2

    ax.text(10.2, 9.75, 'PRIMARY\n(Myeloproliferative)', ha='center', fontsize=7.5,
            fontweight='bold', color='#145A32', va='center',
            bbox=dict(boxstyle='round,pad=0.3', fc='#A9DFBF', ec='#1F7A4D', lw=1.2))
    primary_items = ['Essential thrombocythemia', 'Polycythemia vera', 'CML', 'Primary myelofibrosis']
    y0 = 9.45
    for it in primary_items:
        ax.text(9.2, y0, f'• {it}', fontsize=6, color=C['text_dark'], va='top')
        y0 -= 0.2

    # ── LOW (Thrombocytopenia) ────────────────────────────────────
    arrow(ax, 3.5, 13.95, 1.5, 13.95)
    ax.text(1.85, 14.12, '↓ <150k', fontsize=8, color='#C0392B', fontweight='bold')
    draw_box(ax, 0.75, 13.95, 1.3, 0.55, 'THROMBO-\nCYTOPENIA', '#C0392B', fontsize=8, bold=True)
    arrow(ax, 0.75, 13.68, 0.75, 13.1)
    draw_box(ax, 0.75, 12.85, 2.8, 0.45,
             'Peripheral smear → exclude\nPseudothrombocytopenia (EDTA clumps)',
             '#7F8C8D', tc='white', fontsize=6.8, wrap_width=32)
    arrow(ax, 0.75, 12.62, 0.75, 12.1)
    draw_diamond(ax, 0.75, 11.75, 1.35, 0.65, 'Bleeding\nSeverity?', '#922B21', fontsize=7)
    ax.text(0.9, 11.38, '<10k: HIGH risk spontaneous bleed', fontsize=6.2, color='#C0392B')
    ax.text(0.9, 11.18, '10–50k: Bleeding with trauma/surgery', fontsize=6.2, color='#E67E22')
    ax.text(0.9, 10.98, '>50k: Usually asymptomatic', fontsize=6.2, color='#27AE60')

    # 3 mechanism columns
    col_xs_p = [1.4, 5.5, 9.7]
    mech_data_p = [
        ('↓ Production', '#C0392B',
         ['Aplastic anemia', 'Chemotherapy/radiation', 'Vit B12/folate deficiency',
          'Myelodysplastic syndrome', 'Marrow infiltration', 'Drugs (thiazides, linezolid)',
          'SLE, alcohol']),
        ('Consumption /\nImmune Destruction', '#8E44AD',
         ['ITP (immune)', 'Heparin-induced\nthrombocytopenia (HIT)',
          'Drug-induced (quinine, sulfa)', 'TTP / HUS (microangiopathic)',
          'DIC (check fibrinogen/PT)', 'Neonatal alloimmune TP',
          'Preeclampsia / HELLP']),
        ('Sequestration /\nDilutional', '#2980B9',
         ['Hypersplenism (cirrhosis)', 'Portal hypertension',
          'Storage diseases (Gaucher)', 'Massive transfusion',
          'Gestational thrombocytopenia']),
    ]

    arrow(ax, 0.75, 10.82, 0.75, 10.35)
    ax.text(0.85, 10.55, 'Classify:', fontsize=7, color='#922B21', fontweight='bold')

    mech_y_top = 10.1
    mech_h = 0.42
    for mx, (title, col, items) in zip(col_xs_p, mech_data_p):
        draw_box(ax, mx, mech_y_top, 2.4, mech_h, title, col, fontsize=7.5, bold=True, wrap_width=20)
        y0 = mech_y_top - mech_h/2 - 0.22
        for it in items:
            lines = textwrap.wrap(it, 22)
            for line in lines:
                ax.text(mx - 1.1, y0, f'• {line}', fontsize=5.8, color=C['text_dark'], va='top')
                y0 -= 0.185

    # ── Normal note ───────────────────────────────────────────────
    arrow(ax, 5.5, 13.6, 5.5, 13.05)
    ax.text(5.65, 13.32, 'Normal\n150–400k', fontsize=6.5, color='#1F7A4D', fontweight='bold')
    draw_box(ax, 5.5, 12.8, 3.5, 0.38,
             'Normal platelets — correlate clinically, check smear morphology',
             '#1F7A4D', fontsize=7, wrap_width=38)

    # ── RDW / Peripheral Smear key note ──────────────────────────
    note_box = FancyBboxPatch((2.5, 2.5), 6.0, 2.2, boxstyle='round,pad=0.15',
                              facecolor='#FEF9E7', edgecolor='#D4AC0D', lw=1.5)
    ax.add_patch(note_box)
    ax.text(5.5, 4.57, '⚠  THROMBOCYTOPENIA — KEY NEXT STEPS',
            fontsize=8.5, fontweight='bold', color='#7D6608', ha='center')
    next_steps = [
        '1. Always confirm with peripheral smear before acting on low platelet count.',
        '2. Check coagulation (PT/INR, aPTT, fibrinogen) if DIC suspected.',
        '3. If HIT suspected: stop heparin immediately; use alternative anticoagulation.',
        '4. Check LDH, haptoglobin, schistocytes on smear if TTP/HUS suspected.',
        '5. Transfuse platelets: <10k (prophylactic), <50k (before procedure).',
    ]
    y0 = 4.27
    for s in next_steps:
        lines = textwrap.wrap(s, 60)
        for line in lines:
            ax.text(2.7, y0, line, fontsize=6.5, color='#4D4D00', va='top')
            y0 -= 0.27

    ax.text(5.5, 0.18, 'Orris CBC Flowchart  |  Based on: Textbook of Family Medicine 9e, Goldman-Cecil Medicine, Rosen\'s Emergency Medicine 9e',
            ha='center', fontsize=6, color='#7F8C8D', style='italic')

    plt.tight_layout(pad=0)
    pdf.savefig(fig, bbox_inches='tight', dpi=200)
    plt.close(fig)


# ══════════════════════════════════════════════════════════════════
# PAGE 4 — Summary / Master Table
# ══════════════════════════════════════════════════════════════════
def page_summary(pdf):
    fig, ax = plt.subplots(figsize=(11, 17))
    ax.set_xlim(0, 11)
    ax.set_ylim(0, 17)
    ax.axis('off')
    fig.patch.set_facecolor('#F7F9FC')

    header = FancyBboxPatch((0, 15.8), 11, 1.1, boxstyle='square',
                            facecolor='#1A3A5C', edgecolor='none')
    ax.add_patch(header)
    ax.text(5.5, 16.4, 'CBC INTERPRETATION — MASTER REFERENCE SUMMARY',
            ha='center', va='center', fontsize=13, color='white', fontweight='bold')
    ax.text(5.5, 16.05, 'Page 4 of 4  |  Orris Clinical Reference',
            ha='center', va='center', fontsize=8, color='#AED6F1')

    # Table headers
    headers = ['CBC Parameter', 'HIGH (↑)', 'LOW (↓) / Absent', 'Key Next Test']
    col_x = [0.1, 2.8, 6.2, 9.1]
    col_w = [2.7, 3.3, 2.9, 2.0]

    header_row = FancyBboxPatch((0.05, 14.8), 10.9, 0.5,
                                boxstyle='square', facecolor='#2E6DA4', edgecolor='none')
    ax.add_patch(header_row)
    for hx, ht, hw in zip(col_x, headers, col_w):
        ax.text(hx + hw/2, 15.05, ht, fontsize=8, fontweight='bold',
                color='white', ha='center', va='center')

    # Table rows
    rows = [
        ('Hemoglobin /\nHematocrit',
         'Polycythemia vera\nDehydration\nCOPD / altitude\nSmoking',
         'Anemia — classify by MCV\n(see pages 1–2)',
         'MCV, Reticulocyte\ncount, Peripheral smear'),
        ('MCV',
         'Macrocytic: B12/folate def.\nLiver disease, Hypothyroid\nMDS, Drugs (MTX)',
         'Microcytic: Iron deficiency\nThalassemia, Sideroblastic\nanemia, ACD',
         'Ferritin, B12/Folate,\nTSH, LFTs, Hgb electrophoresis'),
        ('RDW',
         'Iron def (early), mixed\ndeficiency, B12/folate def.\n— early anemia',
         'Normal-low: Thalassemia\n(key: low RDW + low MCV)',
         'Ferritin, Hgb electrophoresis'),
        ('WBC (Total)',
         'Leukocytosis: Infection,\nLeukemia, Steroids, Stress',
         'Leukopenia: Viral illness,\nChemo, Aplastic anemia',
         '5-part differential,\nPeripheral smear'),
        ('Neutrophils',
         'Bacterial infection, CML,\nSteroids, G-CSF, Trauma',
         'Viral illness, Drug reaction\nAplastic anemia, SLE, Sepsis',
         'Blood culture, ANC, smear\nfor left shift / blasts'),
        ('Lymphocytes',
         'Viral (EBV/CMV), CLL,\nPertussis, ALL',
         'HIV/AIDS, Steroids,\nChemo, SLE, lymphoma',
         'HIV, EBV/CMV serology,\nFlow cytometry'),
        ('Eosinophils',
         'Parasites, Allergy/Asthma,\nDrug reaction, IBD,\nMyeloproliferative',
         'Cushing syndrome,\nCorticosteroids,\nAcute stress',
         'Stool O&P, IgE, skin prick'),
        ('Monocytes',
         'TB, SBE, Sarcoidosis,\nMalignancy, GI disease',
         'Hairy cell leukemia,\nSteroid onset',
         'BMAT for hairy cell,\nChest X-ray for TB'),
        ('Basophils',
         'CML (hallmark), Allergy,\nPolycythemia vera,\nHypothyroidism',
         'Hyperthyroidism,\nSteroids, Acute stress',
         'BCR-ABL for CML,\nTSH'),
        ('Platelets',
         'Thrombocytosis: Reactive\n(IDA, inflammation) vs.\nPrimary (ET, PV, CML)',
         'Thrombocytopenia: ITP,\nHIT, TTP/HUS, DIC,\nAplastic anemia, B12 def.',
         'Peripheral smear, Coags\n(PT/aPTT/fibrinogen),\nAnti-PF4 for HIT'),
    ]

    alt_colors = ['#FFFFFF', '#EBF5FB']
    y_start = 14.65
    row_h = 1.32
    for i, (param, high, low, nxt) in enumerate(rows):
        fc = alt_colors[i % 2]
        row_bg = FancyBboxPatch((0.05, y_start - row_h), 10.9, row_h - 0.04,
                                boxstyle='square', facecolor=fc, edgecolor='#D5D8DC', lw=0.5)
        ax.add_patch(row_bg)
        ax.text(col_x[0] + col_w[0]/2, y_start - row_h/2, param,
                fontsize=7, fontweight='bold', ha='center', va='center',
                color='#1A3A5C', multialignment='center')
        ax.text(col_x[1] + 0.1, y_start - 0.18, high,
                fontsize=6.5, va='top', color='#C0392B', multialignment='left')
        ax.text(col_x[2] + 0.1, y_start - 0.18, low,
                fontsize=6.5, va='top', color='#2471A3', multialignment='left')
        ax.text(col_x[3] + 0.1, y_start - 0.18, nxt,
                fontsize=6.3, va='top', color='#1F7A4D', multialignment='left')
        y_start -= row_h

    ax.text(5.5, 0.4, 'Normal values (adult): Hgb >13 g/dL (M), >12 g/dL (F)  •  WBC 4–11 × 10³/μL  •  Platelets 150–400 × 10³/μL  •  MCV 80–100 fL',
            ha='center', fontsize=7, color='#2C3E50',
            bbox=dict(boxstyle='round,pad=0.3', fc='#EBF5FB', ec='#2E6DA4', lw=1))
    ax.text(5.5, 0.12, 'Orris CBC Flowchart  |  Sources: Textbook of Family Medicine 9e • Goldman-Cecil Medicine • Rosen\'s Emergency Medicine 9e • Tietz Laboratory Medicine 7e',
            ha='center', fontsize=6, color='#7F8C8D', style='italic')

    plt.tight_layout(pad=0)
    pdf.savefig(fig, bbox_inches='tight', dpi=200)
    plt.close(fig)


# ── GENERATE PDF ─────────────────────────────────────────────────
output_path = '/home/daytona/workspace/cbc-flowchart/CBC_Clinical_Flowchart.pdf'
with PdfPages(output_path) as pdf:
    page_rbc(pdf)
    page_wbc(pdf)
    page_platelet(pdf)
    page_summary(pdf)

    d = pdf.infodict()
    d['Title'] = 'CBC Clinical Interpretation Flowchart'
    d['Author'] = 'Orris Clinical Reference'
    d['Subject'] = 'Complete Blood Count Differential Diagnosis'
    d['Keywords'] = 'CBC, anemia, leukocytosis, thrombocytopenia, hematology'

print(f"PDF generated: {output_path}")

cd /home/daytona/workspace/cbc-flowchart && python3 generate_flowchart.py 2>&1