@precisa-saude/fhir 0.16.3 → 0.16.5

package/dist/chunk-V5YVSHV7.cjs.map

@@ -0,0 +1 @@
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* Biomarker Reference Ranges\n *\n * Single source of truth for biomarker reference ranges used by both\n * web app (for display) and API (for fallback when LLM doesn't extract ranges).\n *\n * Data sources (priority order):\n * 1. Brazilian Government - SBPC/ML (Sociedade Brasileira de Patologia Clínica) guidelines\n * 2. International Standards - WHO, clinical laboratory guidelines\n * 3. Specific Labs - Fleury, Weinmann, Quest, LabCorp (when above unavailable)\n */\n\nimport { getCanonicalUnit as getCanonicalUnitForCode } from './units';\n\n// =============================================================================\n// TYPES\n// =============================================================================\n\n/**\n * Sex-specific key for reference ranges\n */\nexport type SexKey = 'M' | 'F' | 'all';\n\n/**\n * Pré-condição de jejum para a faixa de referência.\n *\n * - `strict`: coleta exige jejum mínimo (ex.: glicemia de jejum, insulina).\n * - `preferred`: jejum recomendado, mas faixa aplicável em não-jejum\n *   (ex.: perfil lipídico pós-SBC 2017, com corte de triglicérides distinto).\n * - `not-required`: valor independe do estado prandial (ex.: HbA1c, TSH).\n */\nexport type FastingRequirement = 'strict' | 'preferred' | 'not-required';\n\n/**\n * Reference range configuration for a biomarker\n */\nexport interface BiomarkerReferenceRange {\n  /**\n   * Pré-condição de jejum para a interpretação da faixa. Opcional;\n   * consumidores devem aplicar sinalização adequada quando `strict`.\n   */\n  fastingRequired?: FastingRequirement;\n  max?: number;\n  min?: number;\n  optimalMax?: number;\n  optimalMin?: number;\n  /**\n   * Chave de fonte bibliográfica (ex.: `'sbc-lipids-2025'`). Propagada\n   * do `BiomarkerRangeDefinition` no momento da consulta; ausente em\n   * faixas declaradas diretamente sem uma definição completa.\n   */\n  source?: string;\n  unit: string;\n  warningMax?: number;\n  /**\n   * Análogo de `warningMax` para marcadores `higher-better`. Define o limite\n   * inferior da zona de atenção (âmbar): valores entre `warningMin` e `min`\n   * são âmbar e abaixo de `warningMin` são vermelhos. (`warningMax` cobre o\n   * caso `lower-better`, com a zona âmbar acima de `max`.)\n   */\n  warningMin?: number;\n}\n\n/**\n * Trimestre gestacional. Usado em variantes e no contexto de consulta\n * para matching de faixas específicas da gestação.\n */\nexport type PregnancyTrimester = 1 | 2 | 3;\n\n/**\n * A variant of a reference range that applies to a specific sex, age group,\n * and/or pregnancy state.\n *\n * Ordem de avaliação: variantes são processadas na ordem em que aparecem.\n * Para que usuárias gestantes recebam a variante gestacional correta,\n * essas variantes devem ser listadas **antes** das variantes por idade/sexo.\n */\nexport interface RangeVariant {\n  ageMax?: number;\n  ageMin?: number;\n  pregnancyTrimester?: PregnancyTrimester;\n  /**\n   * Quando `true`, a variante só se aplica a contextos de gestação.\n   * Se `pregnancyTrimester` estiver definido, o trimestre deve coincidir.\n   */\n  pregnant?: boolean;\n  range: BiomarkerReferenceRange;\n  sex: SexKey;\n}\n\n/**\n * Extended biomarker range definition with sex/age-specific variants\n */\n/**\n * Direction indicates whether exceeding the reference range on one side is benign.\n * - 'range': both above-max and below-min are abnormal (default)\n * - 'higher-better': above-max is normal (e.g., BMC, HDL)\n * - 'lower-better': below-min is normal (e.g., LDL, CRP)\n */\nexport type RangeDirection = 'range' | 'higher-better' | 'lower-better';\n\nexport interface BiomarkerRangeDefinition {\n  default: BiomarkerReferenceRange;\n  direction?: RangeDirection;\n  /**\n   * Chave de fonte bibliográfica, opcionalmente com localizador.\n   *\n   * Formato: `'chave'` ou `'chave:localizador'`\n   *\n   * Exemplos:\n   * - `'sbc-lipids-2017'` — fonte sem localização específica\n   * - `'sbc-lipids-2017:p15'` — página 15\n   * - `'sbpc-ml-2021:t4.1'` — tabela 4.1\n   *\n   * As chaves devem corresponder a entradas em `SOURCE_REGISTRY` (sources.ts).\n   * Consulte `docs/fontes-referencia.md` para a bibliografia completa em formato ABNT.\n   */\n  source?: string;\n  variants?: RangeVariant[];\n}\n\n/**\n * User context for personalized reference range lookup.\n *\n * Para gestação, defina `pregnant: true` e, quando disponível,\n * `pregnancyTrimester` para obter a variante trimestre-específica.\n */\nexport interface ReferenceRangeContext {\n  age?: number;\n  biologicalSex?: 'M' | 'F';\n  pregnancyTrimester?: PregnancyTrimester;\n  pregnant?: boolean;\n}\n\n// =============================================================================\n// BIOMARKER RANGE DEFINITIONS\n// =============================================================================\n\n/**\n * Comprehensive biomarker reference range definitions with sex/age-specific variants\n *\n * Each marker has a default range (used as fallback) and optional variants\n * for sex/age-specific ranges.\n */\nexport const biomarkerRangeDefinitions: Record<string, BiomarkerRangeDefinition> = {\n  Albumin_Creatinine_Ratio: {\n    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: 'mg/g' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Adiponectin: {\n    default: { max: 26, min: 4, optimalMax: 20, optimalMin: 8, unit: 'mcg/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  ADMA: {\n    default: { max: 0.7, min: 0.3, optimalMax: 0.55, optimalMin: 0.3, unit: 'umol/L' },\n    source: 'nemeth-adma-2017',\n  },\n\n  AFP: {\n    default: { max: 10, min: 0, optimalMax: 8, optimalMin: 0, unit: 'ng/mL' },\n    source: 'sturgeon-nacb-2008',\n  },\n\n  Albumin_Globulin_Ratio: {\n    default: { max: 2.5, min: 1.0, optimalMax: 2.2, optimalMin: 1.2, unit: '' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Albumin: {\n    default: { max: 5.0, min: 3.5, optimalMax: 4.8, optimalMin: 4.0, unit: 'g/dL' },\n    source: 'pns-bioquimica-2019',\n  },\n\n  AlkalinePhosphatase: {\n    default: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: 'U/L' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: 'U/L' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 104, min: 35, optimalMax: 90, optimalMin: 40, unit: 'U/L' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  ALT: {\n    default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: 'U/L' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 56, min: 7, optimalMax: 35, optimalMin: 10, unit: 'U/L' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 45, min: 7, optimalMax: 30, optimalMin: 10, unit: 'U/L' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  // AMH — fortemente dependente de idade e sexo. As variantes femininas por\n  // faixa etária são a referência clínica; o `default` foi ajustado para\n  // refletir uma faixa adulta conservadora (~18-40 anos, mulheres em idade\n  // reprodutiva geral). optimalMax anterior (6.9 ng/mL) sobrepunha-se a\n  // valores sugestivos de SOP ou risco de OHSS; clinicamente, valores acima\n  // de ~4 ng/mL já merecem investigação.\n  AMH: {\n    default: { max: 6.0, min: 1.0, optimalMax: 4.0, optimalMin: 1.5, unit: 'ng/mL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMax: 24,\n        ageMin: 18,\n        range: { max: 13.0, min: 1.5, optimalMax: 10.0, optimalMin: 3.0, unit: 'ng/mL' },\n        sex: 'F',\n      },\n      {\n        ageMax: 30,\n        ageMin: 25,\n        range: { max: 10.0, min: 1.5, optimalMax: 8.0, optimalMin: 2.5, unit: 'ng/mL' },\n        sex: 'F',\n      },\n      {\n        ageMax: 35,\n        ageMin: 31,\n        range: { max: 8.0, min: 1.0, optimalMax: 6.0, optimalMin: 2.0, unit: 'ng/mL' },\n        sex: 'F',\n      },\n      {\n        ageMax: 40,\n        ageMin: 36,\n        range: { max: 6.0, min: 0.5, optimalMax: 4.0, optimalMin: 1.0, unit: 'ng/mL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 41,\n        range: { max: 3.0, min: 0.1, optimalMax: 2.0, optimalMin: 0.5, unit: 'ng/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Ammonia: {\n    default: { max: 45, min: 15, optimalMax: 40, optimalMin: 20, unit: 'umol/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  AntiThyroglobulin: {\n    default: { max: 115, min: 0, optimalMax: 40, optimalMin: 0, unit: 'IU/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  AntiTPO: {\n    default: { max: 34, min: 0, optimalMax: 9, optimalMin: 0, unit: 'IU/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // Aortic valve calcium — no standardized clinical threshold; use mild cutoff\n  // Cálcio de válvula aórtica — usa mesma classificação Agatston\n  AorticValveCalcium: {\n    default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: 'AU' },\n    direction: 'lower-better',\n    source: 'rumberger-cac-1999',\n  },\n\n  ApoA1: {\n    default: { max: 200, min: 100, optimalMax: 180, optimalMin: 120, unit: 'mg/dL' },\n    source: 'contois-apoa1-1996',\n  },\n\n  ApoB: {\n    default: { max: 90, min: 0, optimalMax: 70, optimalMin: 0, unit: 'mg/dL' },\n    direction: 'lower-better',\n    source: 'sbc-lipids-2025',\n  },\n\n  ApoCIII: {\n    default: { max: 10, min: 0, optimalMax: 7, optimalMin: 0, unit: 'mg/dL' },\n    source: 'khetarpal-apociii-2016',\n  },\n\n  // ApoCIII/ApoA1 Ratio: derivado de ApoCIII (~10 mg/dL) e ApoA1 (~100-150 mg/dL)\n  // NOTA: corte de 0.15 sem fonte publicada — valor calculado, não validado clinicamente\n  ApoCIII_ApoA1_Ratio: {\n    default: { max: 0.15, min: 0, optimalMax: 0.1, optimalMin: 0, unit: '' },\n  },\n\n  Omega6_AA: {\n    default: { max: 15.0, min: 5.0, optimalMax: 12.0, optimalMin: 7.0, unit: '%' },\n    source: 'simopoulos-omega-ratio-2002',\n  },\n\n  // Razão Ácido Araquidônico/EPA (sangue total) — `lower-better`: razão menor =\n  // menos eicosanoides pró-inflamatórios. NÃO há intervalo de referência\n  // validado em periódico para esta razão; o intervalo 3,7–40,7 é o de\n  // referência laboratorial do ensaio Quest/Cleveland HeartLab OmegaCheck®\n  // (população interna do laboratório, sem fonte primária publicada). É\n  // corroborado por Torrissen 2025 (>500 mil amostras de sangue total): a\n  // mediana brasileira (≈18,8) e as ocidentais (EUA ≈22,3; Europa ≈14,2) caem\n  // dentro do intervalo. Sem `optimal*`: não há corte ótimo de AA/EPA com fonte.\n  // Em telas de relatório único, prefira o intervalo impresso pelo laboratório.\n  AA_EPA_Ratio: {\n    default: { max: 40.7, min: 3.7, unit: '' },\n    direction: 'lower-better',\n    source: 'torrissen-omega3-dbs-2025',\n  },\n\n  Arsenic: {\n    default: { max: 35, min: 0, optimalMax: 20, optimalMin: 0, unit: 'mcg/L' },\n    source: 'nr7-pcmso-2020',\n  },\n\n  AST: {\n    default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: 'U/L' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 40, min: 10, optimalMax: 30, optimalMin: 10, unit: 'U/L' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 32, min: 9, optimalMax: 25, optimalMin: 10, unit: 'U/L' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Basophils: {\n    default: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: '%' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Basophils_Abs: {\n    default: { max: 0.1, min: 0, optimalMax: 0.05, optimalMin: 0, unit: 'K/uL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Bicarbonate: {\n    default: { max: 29, min: 23, optimalMax: 28, optimalMin: 24, unit: 'mEq/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // β-Hidroxibutirato (BHB) sérico — corpos cetônicos. Faixa derivada de\n  // amostra populacional não-jejum (German National Cohort, n=304, 20–69 a)\n  // como percentis 2,5–97,5: 0,02–0,28 mmol/L. Em jejum prolongado ou\n  // cetose nutricional, valores acima de 0,5 mmol/L são esperados; o limite\n  // superior aqui reflete estado pós-prandial habitual, não jejum.\n  BetaHydroxybutyrate: {\n    default: { max: 0.28, min: 0.02, optimalMax: 0.28, optimalMin: 0.02, unit: 'mmol/L' },\n    source: 'klee-bhb-2020',\n  },\n\n  BilirubinDirect: {\n    default: { max: 0.3, min: 0, optimalMax: 0.2, optimalMin: 0, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  BilirubinIndirect: {\n    default: { max: 0.8, min: 0, optimalMax: 0.6, optimalMin: 0, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  BilirubinTotal: {\n    default: { max: 1.2, min: 0.1, optimalMax: 0.9, optimalMin: 0.2, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // BNP: 35 pg/mL = corte não-agudo para triagem de IC (SBC IC 2018)\n  BNP: {\n    default: { max: 35, min: 0, optimalMax: 20, optimalMin: 0, unit: 'pg/mL' },\n    source: 'sbc-ic-2018',\n  },\n\n  // Razão BUN/Creatinina — faixa 10-20 aplica-se ao Nitrogênio Ureico (BUN).\n  // Laboratórios brasileiros que reportam Ureia (e não BUN) usam razão\n  // Ureia/Creatinina, cuja faixa normal é aproximadamente 21-43\n  // (Ureia ≈ BUN × 2,14). O biomarcador atualmente assume a convenção BUN;\n  // consumidores que dosem Ureia devem converter ou reportar como razão\n  // distinta. Ver issue #41 para alinhamento de nomenclatura/LOINC.\n  BUN_Creatinine_Ratio: {\n    default: { max: 20, min: 10, optimalMax: 18, optimalMin: 12, unit: '' },\n    source: 'tietz-7ed-2015',\n  },\n\n  CA125: {\n    default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: 'U/mL' },\n    source: 'sturgeon-nacb-2008',\n  },\n\n  CA199: {\n    default: { max: 37, min: 0, optimalMax: 30, optimalMin: 0, unit: 'U/mL' },\n    source: 'sturgeon-nacb-2008',\n  },\n\n  // CAC: Agatston classification — 0=none, 1-99=mild, 100-399=moderate, 400+=severe\n  // max=99 so only moderate+ scores (≥100) flag as ANORMAL; optimalMax=0 (zero is ideal)\n  CAC: {\n    default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: 'AU' },\n    direction: 'lower-better',\n    source: 'rumberger-cac-1999',\n  },\n\n  // Per-vessel scores — same Agatston classification applied per vessel\n  CAC_LAD: {\n    default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: 'AU' },\n    direction: 'lower-better',\n    source: 'rumberger-cac-1999',\n  },\n\n  CAC_LCX: {\n    default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: 'AU' },\n    direction: 'lower-better',\n    source: 'rumberger-cac-1999',\n  },\n\n  CAC_LMA: {\n    default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: 'AU' },\n    direction: 'lower-better',\n    source: 'rumberger-cac-1999',\n  },\n\n  CAC_Percentile: {\n    default: { max: 50, min: 0, optimalMax: 25, optimalMin: 0, unit: '%', warningMax: 75 },\n    direction: 'lower-better',\n    source: 'rumberger-cac-1999',\n  },\n\n  CAC_RCA: {\n    default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: 'AU' },\n    direction: 'lower-better',\n    source: 'rumberger-cac-1999',\n  },\n\n  Cadmium: {\n    default: { max: 1.2, min: 0, optimalMax: 0.5, optimalMin: 0, unit: 'mcg/L' },\n    source: 'nr7-pcmso-2020',\n  },\n\n  Calcium: {\n    default: { max: 10.5, min: 8.5, optimalMax: 10.0, optimalMin: 9.0, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  CEA: {\n    default: { max: 3.0, min: 0, optimalMax: 2.5, optimalMin: 0, unit: 'ng/mL' },\n    source: 'sturgeon-nacb-2008',\n  },\n\n  // CK: valores conservadores baseados em faixas laboratoriais típicas\n  CK: {\n    default: { max: 190, min: 30, optimalMax: 170, optimalMin: 40, unit: 'U/L' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      { sex: 'F', range: { max: 170, min: 30, optimalMax: 150, optimalMin: 40, unit: 'U/L' } },\n    ],\n  },\n\n  Chloride: {\n    default: { max: 106, min: 98, optimalMax: 105, optimalMin: 100, unit: 'mEq/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // Colesterol total — SBC 2017/2025: valor desejável < 190 mg/dL para adultos,\n  // com ou sem jejum. Limite anterior (200 mg/dL) refletia a diretriz ATP III\n  // (NCEP, 2002), superada pelas atualizações brasileiras.\n  Cholesterol: {\n    default: { max: 190, min: 0, optimalMax: 170, optimalMin: 0, unit: 'mg/dL' },\n    source: 'sbc-lipids-2025',\n  },\n\n  // Índice de Castelli I (CT/HDL-c)\n  Cholesterol_HDL_Ratio: {\n    // Índice de Castelli I — SBC 2017: M <4.9, F <4.3\n    default: { max: 4.9, min: 0, optimalMax: 3.5, optimalMin: 0, unit: '' },\n    direction: 'lower-better',\n    source: 'castelli-ratio-1992',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 4.9, min: 0, optimalMax: 4.0, optimalMin: 0, unit: '' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 4.3, min: 0, optimalMax: 3.5, optimalMin: 0, unit: '' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  CO2: {\n    default: { max: 29, min: 23, optimalMax: 28, optimalMin: 24, unit: 'mEq/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Copper: {\n    default: { max: 175, min: 70, optimalMax: 150, optimalMin: 85, unit: 'mcg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  CoQ10: {\n    default: { max: 1.5, min: 0.5, optimalMax: 1.3, optimalMin: 0.7, unit: 'mg/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Cortisol: {\n    default: { max: 25, min: 5, optimalMax: 20, optimalMin: 10, unit: 'mcg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  CortisolFree: {\n    default: { max: 2.5, min: 0.5, optimalMax: 2.0, optimalMin: 0.8, unit: 'mcg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  CPeptide: {\n    default: {\n      fastingRequired: 'strict',\n      max: 3.9,\n      min: 0.8,\n      optimalMax: 3.0,\n      optimalMin: 1.0,\n      unit: 'ng/mL',\n    },\n    source: 'tietz-7ed-2015',\n  },\n\n  Creatinine: {\n    default: { max: 1.2, min: 0.6, optimalMax: 1.0, optimalMin: 0.7, unit: 'mg/dL' },\n    source: 'pns-bioquimica-2019',\n    variants: [\n      // Gestação: hiperfiltração glomerular (↑ 40–50% GFR) reduz a creatinina\n      // sérica. Valores \"normais\" de não-gestante podem sinalizar disfunção\n      // renal em gestante. Limites tipicamente citados: 0.4–0.8 mg/dL.\n      {\n        pregnant: true,\n        range: { max: 0.8, min: 0.4, optimalMax: 0.7, optimalMin: 0.5, unit: 'mg/dL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 18,\n        range: { max: 1.3, min: 0.7, optimalMax: 1.1, optimalMin: 0.8, unit: 'mg/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 1.1, min: 0.5, optimalMax: 0.9, optimalMin: 0.6, unit: 'mg/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  CRP: {\n    default: { max: 3.0, min: 0, optimalMax: 1.0, optimalMin: 0, unit: 'mg/L' },\n    direction: 'lower-better',\n    source: 'tietz-7ed-2015',\n  },\n\n  CystatinC: {\n    default: { max: 1.0, min: 0.5, optimalMax: 0.9, optimalMin: 0.6, unit: 'mg/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // D-Dímero — exame de exclusão de TEV (tromboembolismo venoso) com\n  // ponto de corte único, não uma faixa graduada. Valores < 500 ng/mL\n  // têm alto valor preditivo negativo; acima disso a investigação\n  // clínica decide. Removidos `optimalMin/optimalMax` porque a\n  // dicotomia clínica (positivo/negativo para exclusão) não é melhor\n  // representada por zonas verde/amarela. Em pacientes > 50 anos,\n  // diretrizes (ESC 2019, ACEP) recomendam corte ajustado pela idade:\n  // idade × 10 ng/mL (até 750 ng/mL aos 75+).\n  DDimer: {\n    default: { max: 500, min: 0, unit: 'ng/mL' },\n    direction: 'lower-better',\n    source: 'wells-ddimer-2003',\n    variants: [\n      // Corte ajustado por idade — ESC 2019 (Konstantinides et al.) e\n      // ACEP recomendam em pacientes não gestantes ≥ 50 anos com\n      // probabilidade clínica baixa/intermediária de TEV. Fórmula:\n      // idade × 10 ng/mL. Aproximação por faixas etárias.\n      { ageMax: 59, ageMin: 50, range: { max: 590, min: 0, unit: 'ng/mL' }, sex: 'all' },\n      { ageMax: 69, ageMin: 60, range: { max: 690, min: 0, unit: 'ng/mL' }, sex: 'all' },\n      { ageMin: 70, range: { max: 750, min: 0, unit: 'ng/mL' }, sex: 'all' },\n    ],\n  },\n\n  Omega3_DHA: {\n    default: { max: 8.0, min: 2.0, optimalMax: 6.5, optimalMin: 3.5, unit: '%' },\n    source: 'harris-omega3-2004',\n  },\n\n  DHEAS: {\n    default: { max: 500, min: 100, optimalMax: 400, optimalMin: 150, unit: 'mcg/dL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMax: 39,\n        ageMin: 18,\n        range: { max: 640, min: 280, optimalMax: 500, optimalMin: 300, unit: 'mcg/dL' },\n        sex: 'M',\n      },\n      {\n        ageMax: 59,\n        ageMin: 40,\n        range: { max: 520, min: 120, optimalMax: 400, optimalMin: 150, unit: 'mcg/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 60,\n        range: { max: 290, min: 42, optimalMax: 220, optimalMin: 80, unit: 'mcg/dL' },\n        sex: 'M',\n      },\n      {\n        ageMax: 39,\n        ageMin: 18,\n        range: { max: 380, min: 65, optimalMax: 300, optimalMin: 100, unit: 'mcg/dL' },\n        sex: 'F',\n      },\n      {\n        ageMax: 59,\n        ageMin: 40,\n        range: { max: 240, min: 32, optimalMax: 180, optimalMin: 60, unit: 'mcg/dL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 60,\n        range: { max: 140, min: 18, optimalMax: 100, optimalMin: 30, unit: 'mcg/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Omega3_DPA: {\n    default: { max: 2.0, min: 0.3, optimalMax: 1.5, optimalMin: 0.5, unit: '%' },\n    source: 'harris-omega3-2004',\n  },\n\n  eGFR: {\n    default: { max: 120, min: 60, optimalMax: 120, optimalMin: 90, unit: 'mL/min/1.73m²' },\n    // KDIGO 2024: TFG 60-89 (G2) sem marcador de lesão renal não é DRC, em\n    // nenhuma faixa etária. A variante por idade que existia aqui rebaixava o\n    // piso só para 60+ e ainda limitava o teto a 90, o que sinalizava como\n    // alterado qualquer idoso com função preservada.\n    source: 'kdigo-ckd-2024',\n  },\n\n  Eosinophils: {\n    default: { max: 5, min: 0, optimalMax: 4, optimalMin: 1, unit: '%' },\n    direction: 'lower-better',\n    source: 'pns-hemograma-2019',\n  },\n\n  Eosinophils_Abs: {\n    default: { max: 0.5, min: 0, optimalMax: 0.3, optimalMin: 0, unit: 'K/uL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Omega3_EPA: {\n    default: { max: 3.5, min: 0.5, optimalMax: 2.5, optimalMin: 1.0, unit: '%' },\n    source: 'harris-omega3-2004',\n  },\n\n  EPADPADHA: {\n    default: { max: 10.0, min: 3.0, optimalMax: 9.0, optimalMin: 5.0, unit: '%' },\n    source: 'harris-omega3-2004',\n  },\n\n  ESR: {\n    default: { max: 20, min: 0, optimalMax: 10, optimalMin: 0, unit: 'mm/hr' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Estradiol: {\n    default: { max: 40, min: 10, optimalMax: 35, optimalMin: 15, unit: 'pg/mL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 40, min: 10, optimalMax: 30, optimalMin: 15, unit: 'pg/mL' },\n        sex: 'M',\n      },\n      {\n        ageMax: 50,\n        ageMin: 18,\n        range: { max: 400, min: 30, optimalMax: 300, optimalMin: 50, unit: 'pg/mL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 51,\n        range: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: 'pg/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  F2Isoprostanes: {\n    default: { max: 86, min: 0, optimalMax: 60, optimalMin: 0, unit: 'pg/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // Ferritina — WHO 2020 é o documento de referência específico para avaliação\n  // do status de ferro via ferritina. Importante: inflamação aguda eleva\n  // ferritina (proteína de fase aguda); WHO 2020 recomenda dosagem concomitante\n  // de PCR para interpretação em contexto inflamatório (fora do escopo deste\n  // tipo de faixa, mas documentado aqui para consumidores).\n  Ferritin: {\n    default: { max: 150, min: 12, optimalMax: 120, optimalMin: 30, unit: 'ng/mL' },\n    source: 'who-iron-2020',\n    variants: [\n      // Gestação: ferritina cai fisiologicamente no 2º/3º trimestre pela expansão\n      // do volume plasmático e maior demanda fetal. WHO 2020: <15 ng/mL sugere\n      // depleção; muitas diretrizes nacionais usam <30 como gatilho mais sensível\n      // na gestação dada a alta prevalência de deficiência subclínica.\n      {\n        pregnant: true,\n        range: { max: 120, min: 15, optimalMax: 80, optimalMin: 30, unit: 'ng/mL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 18,\n        range: { max: 250, min: 20, optimalMax: 200, optimalMin: 40, unit: 'ng/mL' },\n        sex: 'M',\n      },\n      {\n        ageMax: 50,\n        ageMin: 18,\n        range: { max: 120, min: 10, optimalMax: 80, optimalMin: 20, unit: 'ng/mL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 51,\n        range: { max: 200, min: 20, optimalMax: 150, optimalMin: 30, unit: 'ng/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  // Fibrinogênio: 200-400 mg/dL — faixa de referência padrão (método de Clauss)\n  Fibrinogen: {\n    default: { max: 400, min: 200, optimalMax: 350, optimalMin: 250, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  FolicAcid: {\n    default: { max: 20, min: 3, optimalMax: 15, optimalMin: 5, unit: 'ng/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  FSH: {\n    default: { max: 12.4, min: 1.5, optimalMax: 10.0, optimalMin: 3.0, unit: 'mIU/mL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 12.4, min: 1.5, optimalMax: 8.0, optimalMin: 1.5, unit: 'mIU/mL' },\n        sex: 'M',\n      },\n      {\n        ageMax: 50,\n        ageMin: 18,\n        range: { max: 12.5, min: 3.5, optimalMax: 10.0, optimalMin: 3.5, unit: 'mIU/mL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 51,\n        range: { max: 134.8, min: 25.8, optimalMax: 80.0, optimalMin: 25.8, unit: 'mIU/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  GGT: {\n    default: { max: 55, min: 0, optimalMax: 30, optimalMin: 0, unit: 'U/L' },\n    direction: 'lower-better',\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 61, min: 8, optimalMax: 40, optimalMin: 10, unit: 'U/L' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 36, min: 5, optimalMax: 25, optimalMin: 8, unit: 'U/L' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Ghrelin: {\n    default: { max: 1000, min: 300, optimalMax: 800, optimalMin: 400, unit: 'pg/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Globulin: {\n    default: { max: 3.5, min: 2.0, optimalMax: 3.2, optimalMin: 2.3, unit: 'g/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // Glicemia de jejum — 70–99 mg/dL é a faixa de normalidade (SBD 2024, ADA);\n  // hipoglicemia clinicamente acionável em não-diabético é <54 mg/dL (Level 2\n  // ADA/SBD), não 70. O corte 70 era Level 1 (alerta em diabético em tratamento)\n  // e gerava falsos \"abaixo do normal\" em indivíduos saudáveis cuja glicemia\n  // em jejum está fisiologicamente entre 54–70. optimalMin preserva o alvo.\n  Glucose: {\n    default: {\n      fastingRequired: 'strict',\n      max: 100,\n      min: 54,\n      optimalMax: 90,\n      optimalMin: 70,\n      unit: 'mg/dL',\n    },\n    source: 'sbd-diabetes-2024',\n    variants: [\n      // Gestação: DMG (IADPSG/SBD 2024) usa cortes mais restritivos na glicemia\n      // de jejum — ≥92 mg/dL já indica diabetes mellitus gestacional. Portanto\n      // a faixa \"normal\" em gestante vai até 91 mg/dL no jejum.\n      {\n        pregnant: true,\n        range: {\n          fastingRequired: 'strict',\n          max: 91,\n          min: 54,\n          optimalMax: 85,\n          optimalMin: 70,\n          unit: 'mg/dL',\n        },\n        sex: 'F',\n      },\n    ],\n  },\n\n  GlycoMark: {\n    default: { max: 40, min: 10, optimalMax: 35, optimalMin: 15, unit: 'mcg/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  GrowthHormone: {\n    default: { max: 5, min: 0, optimalMax: 3, optimalMin: 0, unit: 'ng/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // HbA1c — SBD 2024 não estabelece piso de referência clinicamente acionável.\n  // Valores <4.0% podem refletir anemia hemolítica, perda sanguínea recente ou\n  // hemoglobinopatia, não patologia do metabolismo glicêmico. Usamos min=2 como\n  // piso de sanidade (HbA1c <2% é quase sempre erro instrumental/entrada) sem\n  // criar flag clínico em valores fisiologicamente baixos. optimalMin preserva\n  // o alvo fisiológico da fração glicada.\n  HbA1c: {\n    default: { max: 5.7, min: 2, optimalMax: 5.3, optimalMin: 4.5, unit: '%' },\n    source: 'sbd-diabetes-2024',\n  },\n\n  Hct: {\n    default: { max: 50, min: 36, optimalMax: 48, optimalMin: 40, unit: '%' },\n    source: 'pns-hemograma-2019',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 54, min: 40, optimalMax: 50, optimalMin: 42, unit: '%' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 48, min: 36, optimalMax: 45, optimalMin: 38, unit: '%' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  // HDL — SBC 2017/2025: desejável > 40 mg/dL (♂) e > 50 mg/dL (♀).\n  // A diretriz NÃO define teto de normalidade — HDL alto é cardioprotetor.\n  // Limites superiores anteriormente fixados em 60 mg/dL geravam falsos\n  // alertas. Mantém-se `max` apenas como limite técnico do gauge (100 mg/dL),\n  // não como ponto de corte clínico; consumidores devem tratar `direction:\n  // higher-better` como sinal autoritativo.\n  HDL: {\n    default: { max: 100, min: 40, optimalMax: 100, optimalMin: 50, unit: 'mg/dL' },\n    direction: 'higher-better',\n    source: 'sbc-lipids-2025',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 100, min: 40, optimalMax: 100, optimalMin: 45, unit: 'mg/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 100, min: 50, optimalMax: 100, optimalMin: 55, unit: 'mg/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  HDL_Large: {\n    // HDL Large: higher is better\n    // Quest Ion Mobility reference: Male 4334-10815, Female 5038-17886 nmol/L, optimal >6729\n    default: { max: 17886, min: 4334, optimalMax: 17886, optimalMin: 6729, unit: 'nmol/L' },\n    direction: 'higher-better',\n    source: 'caulfield-ionmobility-2008',\n  },\n\n  Hgb: {\n    default: { max: 17.5, min: 12.0, optimalMax: 16.0, optimalMin: 13.5, unit: 'g/dL' },\n    source: 'pns-hemograma-2019',\n    variants: [\n      // Gestação: hemodiluição fisiológica reduz o piso aceitável.\n      // OMS e CDC: anemia gestacional quando Hgb <11 g/dL (1º e 3º tri) ou\n      // <10.5 g/dL (2º tri, dilucional mais acentuada). Catch-all adota a\n      // faixa mais conservadora (2º tri) quando trimestre é desconhecido.\n      {\n        pregnant: true,\n        pregnancyTrimester: 1,\n        range: { max: 14.0, min: 11.0, optimalMax: 13.0, optimalMin: 11.5, unit: 'g/dL' },\n        sex: 'F',\n      },\n      {\n        pregnant: true,\n        pregnancyTrimester: 2,\n        range: { max: 14.0, min: 10.5, optimalMax: 13.0, optimalMin: 11.0, unit: 'g/dL' },\n        sex: 'F',\n      },\n      {\n        pregnant: true,\n        pregnancyTrimester: 3,\n        range: { max: 14.0, min: 11.0, optimalMax: 13.0, optimalMin: 11.5, unit: 'g/dL' },\n        sex: 'F',\n      },\n      {\n        pregnant: true,\n        range: { max: 14.0, min: 10.5, optimalMax: 13.0, optimalMin: 11.0, unit: 'g/dL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 18,\n        range: { max: 17.5, min: 13.5, optimalMax: 16.5, optimalMin: 14.0, unit: 'g/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 15.5, min: 12.0, optimalMax: 14.5, optimalMin: 12.5, unit: 'g/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  // HOMA-IR — três faixas do estudo BRAMS (Geloneze et al., 2009) validado em\n  // população urbana brasileira: ótimo até 1.5; sensibilidade reduzida (zona de\n  // atenção) entre 1.5 e 2.71; resistência à insulina acima de 2.71. Tietz 7ª\n  // ed. não publica corte próprio de HOMA-IR. `max` (1.5) delimita o verde,\n  // `warningMax` (2.71) o âmbar e acima disso o vermelho.\n  HOMA_IR: {\n    default: {\n      fastingRequired: 'strict',\n      max: 1.5,\n      min: 0,\n      unit: '',\n      warningMax: 2.71,\n    },\n    direction: 'lower-better',\n    source: 'geloneze-brams-2009',\n  },\n\n  Homocysteine: {\n    default: { max: 15, min: 4, optimalMax: 10, optimalMin: 5, unit: 'umol/L' },\n    direction: 'lower-better',\n    source: 'selhub-homocysteine-1999',\n  },\n\n  IGF1: {\n    default: { max: 350, min: 100, optimalMax: 300, optimalMin: 150, unit: 'ng/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  ImmatureGranulocytes: {\n    default: { max: 1.0, min: 0, optimalMax: 0.5, optimalMin: 0, unit: '%' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Insulin: {\n    default: {\n      fastingRequired: 'strict',\n      max: 25,\n      min: 2,\n      optimalMax: 8,\n      optimalMin: 3,\n      unit: 'uIU/mL',\n    },\n    source: 'tietz-7ed-2015',\n  },\n\n  Iron: {\n    default: { max: 170, min: 60, optimalMax: 140, optimalMin: 80, unit: 'mcg/dL' },\n    source: 'sbpc-ml-2021',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 175, min: 65, optimalMax: 150, optimalMin: 80, unit: 'mcg/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 170, min: 50, optimalMax: 130, optimalMin: 60, unit: 'mcg/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Lactate: {\n    default: { max: 2.2, min: 0.5, optimalMax: 1.8, optimalMin: 0.7, unit: 'mmol/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // DHL/LDH — método IFCC a 37 °C (padrão atual na maioria dos laboratórios\n  // brasileiros). Limites superiores de referência (97,5° percentil) obtidos\n  // por Schumann & Klauke (2002) em indivíduos ≥17 anos: 247 U/L (mulheres)\n  // e 248 U/L (homens). O IFCC publica apenas o limite superior; o limite\n  // inferior é fixado em 0 pois DHL baixa não tem significado clínico.\n  // Não comparar com método Wróblewski-LaDue (faixas mais antigas, ~240–480).\n  LDH: {\n    default: { max: 248, min: 0, optimalMax: 248, optimalMin: 0, unit: 'U/L' },\n    direction: 'lower-better',\n    source: 'schumann-ifcc-ldh-2002',\n    variants: [\n      {\n        ageMin: 17,\n        range: { max: 248, min: 0, optimalMax: 248, optimalMin: 0, unit: 'U/L' },\n        sex: 'M',\n      },\n      {\n        ageMin: 17,\n        range: { max: 247, min: 0, optimalMax: 247, optimalMin: 0, unit: 'U/L' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  LDL: {\n    default: { max: 100, min: 0, optimalMax: 70, optimalMin: 0, unit: 'mg/dL' },\n    direction: 'lower-better',\n    source: 'sbc-lipids-2025',\n  },\n\n  LDL_Medium: {\n    // LDL Medium (LDL Média): lower is better\n    // Quest Ion Mobility reference: Male 167-485, Female 121-397 nmol/L, optimal <215\n    default: { max: 485, min: 121, optimalMax: 215, optimalMin: 121, unit: 'nmol/L' },\n    direction: 'lower-better',\n    source: 'caulfield-ionmobility-2008',\n  },\n\n  LDL_ParticleNumber: {\n    // LDL Particle Number: lower is better\n    // Quest Ion Mobility reference: 1016-2185 nmol/L, optimal <1138\n    default: { max: 2185, min: 1016, optimalMax: 1138, optimalMin: 1016, unit: 'nmol/L' },\n    direction: 'lower-better',\n    source: 'caulfield-ionmobility-2008',\n  },\n\n  LDL_Peak_Size: {\n    // LDL Peak Size: higher is better (larger particles less atherogenic)\n    // Quest Ion Mobility reference: optimal >222.9 Å (22.29 nm)\n    default: { max: 250.0, min: 217.4, optimalMax: 250.0, optimalMin: 222.9, unit: 'Angstrom' },\n    direction: 'higher-better',\n    source: 'caulfield-ionmobility-2008',\n  },\n\n  LDL_Small: {\n    // LDL Small (LDL Pequena): lower is better (small dense LDL is most atherogenic)\n    // Quest Ion Mobility reference: Male 123-441, Female 126-382 nmol/L, optimal <142\n    default: { max: 441, min: 123, optimalMax: 142, optimalMin: 123, unit: 'nmol/L' },\n    direction: 'lower-better',\n    source: 'caulfield-ionmobility-2008',\n  },\n\n  Lead: {\n    default: { max: 5, min: 0, optimalMax: 2, optimalMin: 0, unit: 'mcg/dL' },\n    source: 'nr7-pcmso-2020',\n  },\n\n  Leptin: {\n    default: { max: 15, min: 2, optimalMax: 12, optimalMin: 3, unit: 'ng/mL' },\n    direction: 'lower-better',\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 10, min: 1, optimalMax: 8, optimalMin: 2, unit: 'ng/mL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 25, min: 4, optimalMax: 18, optimalMin: 5, unit: 'ng/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  LH: {\n    default: { max: 8.6, min: 1.7, optimalMax: 8.0, optimalMin: 2.0, unit: 'mIU/mL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 8.6, min: 1.7, optimalMax: 6.0, optimalMin: 1.7, unit: 'mIU/mL' },\n        sex: 'M',\n      },\n      {\n        ageMax: 50,\n        ageMin: 18,\n        range: { max: 12.6, min: 2.4, optimalMax: 10.0, optimalMin: 2.4, unit: 'mIU/mL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 51,\n        range: { max: 58.5, min: 7.7, optimalMax: 40.0, optimalMin: 10.0, unit: 'mIU/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Omega6_LA: {\n    default: { max: 35.0, min: 15.0, optimalMax: 28.0, optimalMin: 18.0, unit: '%' },\n    source: 'simopoulos-omega-ratio-2002',\n  },\n\n  // Lp(a) — SBC 2025 (seção 3.1.1.2.7): níveis ≥ 50 mg/dL ou ≥ 125 nmol/L são\n  // considerados aumentados, com indicação de rastreamento em cascata familiar.\n  // A diretriz recomenda ensaio independente de isoforma medido em nmol/L; a\n  // unidade nmol/L é mantida aqui por refletir o padrão laboratorial atual.\n  // Limites anteriores (max=75) refletiam pontos de corte expressos em mg/dL,\n  // gerando incompatibilidade com a unidade nmol/L declarada.\n  Lipoprotein_a: {\n    default: { max: 125, min: 0, optimalMax: 75, optimalMin: 0, unit: 'nmol/L' },\n    direction: 'lower-better',\n    source: 'sbc-lipids-2025',\n  },\n\n  Lymphocytes: {\n    default: { max: 40, min: 20, optimalMax: 35, optimalMin: 25, unit: '%' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Lymphocytes_Abs: {\n    default: { max: 4.0, min: 1.0, optimalMax: 3.0, optimalMin: 1.5, unit: 'K/uL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Magnesium: {\n    default: { max: 2.2, min: 1.7, optimalMax: 2.1, optimalMin: 1.9, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Magnesium_RBC: {\n    default: { max: 6.8, min: 4.0, optimalMax: 6.0, optimalMin: 4.5, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  MCH: {\n    default: { max: 33, min: 27, optimalMax: 32, optimalMin: 28, unit: 'pg' },\n    source: 'pns-hemograma-2019',\n  },\n\n  MCHC: {\n    default: { max: 36, min: 32, optimalMax: 35, optimalMin: 33, unit: 'g/dL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  MCV: {\n    default: { max: 100, min: 80, optimalMax: 98, optimalMin: 82, unit: 'fL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Mercury: {\n    default: { max: 10, min: 0, optimalMax: 5, optimalMin: 0, unit: 'mcg/L' },\n    source: 'nr7-pcmso-2020',\n  },\n\n  Microalbumin: {\n    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: 'mg/L' },\n    source: 'kdigo-ckd-2024',\n  },\n\n  MMA: {\n    default: { max: 378, min: 0, optimalMax: 270, optimalMin: 0, unit: 'nmol/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Monocytes: {\n    default: { max: 8, min: 2, optimalMax: 7, optimalMin: 3, unit: '%' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Monocytes_Abs: {\n    default: { max: 0.8, min: 0.2, optimalMax: 0.7, optimalMin: 0.3, unit: 'K/uL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  MPV: {\n    default: { max: 11.5, min: 7.5, optimalMax: 10.5, optimalMin: 8.0, unit: 'fL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  // MPO: Meuwese 2007 (EPIC-Norfolk) — risco CV elevado >322 pmol/L\n  Myeloperoxidase: {\n    default: { max: 470, min: 0, optimalMax: 322, optimalMin: 0, unit: 'pmol/L' },\n    source: 'meuwese-mpo-2007',\n  },\n\n  // WBC Differential (%)\n  Neutrophils: {\n    default: { max: 70, min: 40, optimalMax: 65, optimalMin: 50, unit: '%' },\n    source: 'pns-hemograma-2019',\n  },\n\n  // WBC Differential (Absolute)\n  Neutrophils_Abs: {\n    default: { max: 8.0, min: 1.5, optimalMax: 6.0, optimalMin: 2.0, unit: 'K/uL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  NonHDL_Cholesterol: {\n    default: { max: 130, min: 0, optimalMax: 100, optimalMin: 0, unit: 'mg/dL' },\n    direction: 'lower-better',\n    source: 'sbc-lipids-2025',\n  },\n\n  NRBC: {\n    default: { max: 0, min: 0, optimalMax: 0, optimalMin: 0, unit: '/100WBC' },\n    source: 'tietz-7ed-2015',\n  },\n\n  NTproBNP: {\n    default: { max: 125, min: 0, optimalMax: 75, optimalMin: 0, unit: 'pg/mL' },\n    source: 'sbc-ic-2018',\n  },\n\n  Oleic_Acid: {\n    default: { max: 25.0, min: 15.0, optimalMax: 22.0, optimalMin: 18.0, unit: '%' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Omega3_Index: {\n    default: { max: 8.0, min: 4.0, optimalMax: 8.0, optimalMin: 5.5, unit: '%' },\n    source: 'harris-omega3-2004',\n  },\n\n  // Ômega-3 Total (% de ácidos graxos eritrocitários) — Harris & von Schacky\n  // (2004) propõem ≥ 8% como zona ótima de proteção cardiovascular; valores\n  // entre 4% e 8% representam risco intermediário, < 4% risco alto.\n  // optimalMin anterior (5.5%) ficava em zona intermediária, contradizendo\n  // a literatura e o próprio texto educacional do `platform`.\n  Omega3_Total: {\n    default: { max: 12.0, min: 3.0, optimalMax: 10.0, optimalMin: 8.0, unit: '%' },\n    source: 'harris-omega3-2004',\n  },\n\n  Omega6_Total: {\n    default: { max: 40.0, min: 20.0, optimalMax: 35.0, optimalMin: 25.0, unit: '%' },\n    source: 'simopoulos-omega-ratio-2002',\n  },\n\n  Omega6_Omega3_Ratio: {\n    default: { max: 10.0, min: 1.0, optimalMax: 4.0, optimalMin: 1.0, unit: '' },\n    direction: 'lower-better',\n    source: 'simopoulos-omega-ratio-2002',\n  },\n\n  OmegaCheck: {\n    default: { max: 8.0, min: 4.0, optimalMax: 8.0, optimalMin: 5.5, unit: '%' },\n    source: 'harris-omega3-2004',\n  },\n\n  Palmitic_Acid: {\n    default: { max: 30.0, min: 20.0, optimalMax: 27.0, optimalMin: 22.0, unit: '%' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Phosphorus: {\n    default: { max: 4.5, min: 2.5, optimalMax: 4.0, optimalMin: 3.0, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Platelets: {\n    default: { max: 400, min: 150, optimalMax: 350, optimalMin: 180, unit: 'K/uL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Potassium: {\n    default: { max: 5.0, min: 3.5, optimalMax: 4.6, optimalMin: 3.8, unit: 'mEq/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Prealbumin: {\n    default: { max: 38, min: 18, optimalMax: 35, optimalMin: 20, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // Progesterona — varia drasticamente com a fase do ciclo menstrual.\n  // O schema atual não modela fase do ciclo, então adotamos faixas amplas\n  // por sexo: o `default` cobre homens/fase folicular/pós-menopausa; a\n  // variante feminina expande até a faixa esperada de fase lútea\n  // (~3-20 ng/mL). Interpretação correta exige correlação com a fase do\n  // ciclo, indisponível neste contexto.\n  Progesterone: {\n    default: { max: 0.9, min: 0.1, optimalMax: 0.7, optimalMin: 0.2, unit: 'ng/mL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 0.9, min: 0.1, optimalMax: 0.6, optimalMin: 0.2, unit: 'ng/mL' },\n        sex: 'M',\n      },\n      // Mulheres em idade reprodutiva: faixa que abarca fases folicular\n      // (0.1-0.9 ng/mL) e lútea (3-20 ng/mL). Sem contexto de fase do ciclo,\n      // valores intermediários (1-3 ng/mL) ficam em zona ambígua.\n      {\n        ageMax: 50,\n        ageMin: 18,\n        range: { max: 20.0, min: 0.1, optimalMax: 15.0, optimalMin: 0.2, unit: 'ng/mL' },\n        sex: 'F',\n      },\n      // Pós-menopausa: valores tipicamente < 0.5 ng/mL (sem ovulação).\n      {\n        ageMin: 51,\n        range: { max: 0.5, min: 0, optimalMax: 0.3, optimalMin: 0, unit: 'ng/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Prolactin: {\n    default: { max: 18, min: 2, optimalMax: 15, optimalMin: 4, unit: 'ng/mL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 18, min: 2, optimalMax: 15, optimalMin: 4, unit: 'ng/mL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 29, min: 2, optimalMax: 23, optimalMin: 4, unit: 'ng/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  PSA: {\n    default: { max: 4.0, min: 0, optimalMax: 2.5, optimalMin: 0, unit: 'ng/mL' },\n    source: 'sturgeon-nacb-2008',\n    variants: [\n      {\n        ageMax: 49,\n        ageMin: 18,\n        range: { max: 2.5, min: 0, optimalMax: 1.5, optimalMin: 0, unit: 'ng/mL' },\n        sex: 'M',\n      },\n      {\n        ageMax: 59,\n        ageMin: 50,\n        range: { max: 3.5, min: 0, optimalMax: 2.5, optimalMin: 0, unit: 'ng/mL' },\n        sex: 'M',\n      },\n      {\n        ageMax: 69,\n        ageMin: 60,\n        range: { max: 4.5, min: 0, optimalMax: 3.0, optimalMin: 0, unit: 'ng/mL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 70,\n        range: { max: 6.5, min: 0, optimalMax: 4.0, optimalMin: 0, unit: 'ng/mL' },\n        sex: 'M',\n      },\n    ],\n  },\n\n  RBC: {\n    default: { max: 5.5, min: 4.0, optimalMax: 5.2, optimalMin: 4.3, unit: 'M/uL' },\n    source: 'pns-hemograma-2019',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 5.9, min: 4.5, optimalMax: 5.5, optimalMin: 4.7, unit: 'M/uL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 5.2, min: 4.0, optimalMax: 5.0, optimalMin: 4.2, unit: 'M/uL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  RDW: {\n    default: { max: 14.5, min: 11.5, optimalMax: 14.0, optimalMin: 12.0, unit: '%' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Reticulocytes: {\n    default: { max: 2.5, min: 0.5, optimalMax: 2.0, optimalMin: 0.8, unit: '%' },\n    source: 'pns-hemograma-2019',\n  },\n\n  SDMA: {\n    default: { max: 0.6, min: 0.3, optimalMax: 0.5, optimalMin: 0.3, unit: 'umol/L' },\n    source: 'schwedhelm-sdma-2011',\n  },\n\n  Selenium: {\n    default: { max: 150, min: 70, optimalMax: 125, optimalMin: 85, unit: 'mcg/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  SHBG: {\n    default: { max: 54, min: 18, optimalMax: 50, optimalMin: 20, unit: 'nmol/L' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 54, min: 18, optimalMax: 45, optimalMin: 20, unit: 'nmol/L' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 122, min: 24, optimalMax: 90, optimalMin: 30, unit: 'nmol/L' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Sodium: {\n    default: { max: 145, min: 136, optimalMax: 143, optimalMin: 138, unit: 'mEq/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  SpecificGravity_Urine: {\n    default: { max: 1.03, min: 1.005, optimalMax: 1.025, optimalMin: 1.01, unit: 'SG' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Stearic_Acid: {\n    default: { max: 14.0, min: 8.0, optimalMax: 12.0, optimalMin: 10.0, unit: '%' },\n    source: 'tietz-7ed-2015',\n  },\n\n  T3Free: {\n    default: { max: 4.2, min: 2.3, optimalMax: 3.8, optimalMin: 2.8, unit: 'pg/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  T3Reverse: {\n    default: { max: 24, min: 10, optimalMax: 20, optimalMin: 12, unit: 'ng/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  T4Free: {\n    default: { max: 1.8, min: 0.8, optimalMax: 1.5, optimalMin: 1.0, unit: 'ng/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  T4Total: {\n    default: { max: 12.0, min: 4.5, optimalMax: 10.0, optimalMin: 6.0, unit: 'ug/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Testosterone: {\n    default: { max: 1000, min: 300, optimalMax: 800, optimalMin: 500, unit: 'ng/dL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMax: 49,\n        ageMin: 18,\n        range: { max: 1000, min: 300, optimalMax: 800, optimalMin: 500, unit: 'ng/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 50,\n        range: { max: 800, min: 200, optimalMax: 650, optimalMin: 400, unit: 'ng/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 70, min: 15, optimalMax: 50, optimalMin: 20, unit: 'ng/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  TestosteroneBioavailable: {\n    default: { max: 200, min: 50, optimalMax: 150, optimalMin: 80, unit: 'ng/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // TestosteroneFree - using direct immunoassay ranges (Quest/LabCorp standard)\n  // Previous values (9.3-26.5 pg/mL) were based on equilibrium dialysis method\n  TestosteroneFree: {\n    default: { max: 155, min: 35, optimalMax: 120, optimalMin: 50, unit: 'pg/mL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMax: 49,\n        ageMin: 18,\n        range: { max: 155, min: 35, optimalMax: 120, optimalMin: 50, unit: 'pg/mL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 50,\n        range: { max: 130, min: 30, optimalMax: 100, optimalMin: 40, unit: 'pg/mL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 5.0, min: 0.2, optimalMax: 3.0, optimalMin: 0.5, unit: 'pg/mL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  TIBC: {\n    default: { max: 370, min: 250, optimalMax: 350, optimalMin: 280, unit: 'mcg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  TotalProtein: {\n    default: { max: 8.3, min: 6.0, optimalMax: 7.8, optimalMin: 6.5, unit: 'g/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Trans_Fat_Index: {\n    default: { max: 1.0, min: 0, optimalMax: 0.5, optimalMin: 0, unit: '%' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Transferrin: {\n    default: { max: 360, min: 200, optimalMax: 340, optimalMin: 220, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  TransferrinSaturation: {\n    default: { max: 50, min: 20, optimalMax: 45, optimalMin: 25, unit: '%' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 55, min: 20, optimalMax: 45, optimalMin: 25, unit: '%' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 50, min: 15, optimalMax: 40, optimalMin: 20, unit: '%' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  // Triglicérides — SBC 2017/2025 permite dosagem não-jejum com corte distinto\n  // (<175 mg/dL pós-prandial). Marcamos `preferred` para indicar que a faixa\n  // padrão é de jejum, mas não bloqueamos interpretação em não-jejum.\n  Triglycerides: {\n    default: {\n      fastingRequired: 'preferred',\n      max: 150,\n      min: 0,\n      optimalMax: 100,\n      optimalMin: 0,\n      unit: 'mg/dL',\n    },\n    direction: 'lower-better',\n    source: 'sbc-lipids-2025',\n  },\n\n  // TroponinI: 0.04 ng/mL = percentil 99 (ensaio Siemens TnI-Ultra)\n  TroponinI: {\n    default: { max: 0.04, min: 0, optimalMax: 0.02, optimalMin: 0, unit: 'ng/mL' },\n    source: 'keller-tni-2013',\n  },\n\n  // TroponinT: 14 ng/L = percentil 99 hs-cTnT (ensaio Roche Elecsys 5ª geração)\n  TroponinT: {\n    default: { max: 14, min: 0, optimalMax: 10, optimalMin: 0, unit: 'ng/L' },\n    source: 'giannitsis-hstnt-2010',\n  },\n\n  // TSH — 0.4–4.0 é a faixa de referência adulta geral. O alvo 2.5 µIU/mL é\n  // específico do 1º trimestre gestacional (ATA 2017) e não se aplica a\n  // não-gestantes; optimalMax=3.0 reflete o limite superior do tercil \"ótimo\"\n  // sem invadir a faixa subclínica. Variante ageMin=65 mantém limite superior\n  // expandido (tolerância fisiológica do eixo em idosos, SBEM 2013).\n  TSH: {\n    default: { max: 4.0, min: 0.4, optimalMax: 3.0, optimalMin: 1.0, unit: 'uIU/mL' },\n    source: 'sbem-thyroid-2013',\n    variants: [\n      // Variantes gestacionais (ATA 2017 / SBEM): supressão fisiológica por hCG\n      // no 1º trimestre, recuperação progressiva no 2º/3º. Trimestre-específicas\n      // precedem a catch-all; catch-all cobre contexto gestante sem trimestre\n      // conhecido.\n      // optimalMin/optimalMax definem subfaixa \"alvo\" mais estreita que o\n      // intervalo de referência — ex.: 1º tri aceita 0.1–2.5, mas o alvo\n      // terapêutico é 0.5–2.5.\n      {\n        pregnant: true,\n        pregnancyTrimester: 1,\n        range: { max: 2.5, min: 0.1, optimalMax: 2.0, optimalMin: 0.5, unit: 'uIU/mL' },\n        sex: 'F',\n      },\n      {\n        pregnant: true,\n        pregnancyTrimester: 2,\n        range: { max: 3.0, min: 0.2, optimalMax: 2.5, optimalMin: 0.5, unit: 'uIU/mL' },\n        sex: 'F',\n      },\n      {\n        pregnant: true,\n        pregnancyTrimester: 3,\n        range: { max: 3.0, min: 0.3, optimalMax: 2.5, optimalMin: 0.5, unit: 'uIU/mL' },\n        sex: 'F',\n      },\n      // Catch-all gestacional — usada quando o trimestre não é informado.\n      // Adota a faixa mais conservadora (2º/3º trimestre: 0.2–3.0).\n      {\n        pregnant: true,\n        range: { max: 3.0, min: 0.2, optimalMax: 2.5, optimalMin: 0.5, unit: 'uIU/mL' },\n        sex: 'F',\n      },\n      {\n        ageMin: 65,\n        range: { max: 6.0, min: 0.4, optimalMax: 4.0, optimalMin: 1.0, unit: 'uIU/mL' },\n        sex: 'all',\n      },\n    ],\n  },\n\n  // Ureia — convenção brasileira (laboratórios reportam Ureia, não BUN).\n  // Faixa adulta de 15-50 mg/dL (Ureia ≈ BUN × 2,14). Limites anteriores\n  // (7-20 mg/dL) refletiam BUN/Nitrogênio Ureico, gerando falsos diagnósticos\n  // de azotemia em pacientes com Ureia normal. LOINC 3094-0 (BUN) também\n  // deve ser revisto em biomarkers.ts — ver issue #41.\n  Urea: {\n    default: { max: 50, min: 15, optimalMax: 40, optimalMin: 20, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  UricAcid: {\n    default: { max: 7.0, min: 2.5, optimalMax: 5.5, optimalMin: 3.0, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 7.0, min: 3.4, optimalMax: 6.0, optimalMin: 4.0, unit: 'mg/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 6.0, min: 2.4, optimalMax: 5.0, optimalMin: 3.0, unit: 'mg/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  Urobilinogen_Urine: {\n    default: { max: 1.0, min: 0.1, optimalMax: 1.0, optimalMin: 0.1, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  pH_Urine: {\n    default: { max: 8.0, min: 4.5, optimalMax: 7.0, optimalMin: 5.5, unit: 'pH' },\n    source: 'tietz-7ed-2015',\n  },\n\n  HyalineCasts_Urine: {\n    default: { max: 2, min: 0, optimalMax: 1, optimalMin: 0, unit: '/LPF' },\n    source: 'tietz-7ed-2015',\n  },\n\n  RBC_Urine: {\n    default: { max: 3, min: 0, optimalMax: 1, optimalMin: 0, unit: '/HPF' },\n    source: 'tietz-7ed-2015',\n  },\n\n  SquamousEpithelial_Urine: {\n    default: { max: 15, min: 0, optimalMax: 5, optimalMin: 0, unit: '/HPF' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Leukocytes_Urine: {\n    default: { max: 5, min: 0, optimalMax: 2, optimalMin: 0, unit: '/HPF' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Folate: {\n    default: { max: 20, min: 3.9, optimalMax: 17, optimalMin: 5, unit: 'ng/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  VitaminA: {\n    default: { max: 100, min: 20, optimalMax: 80, optimalMin: 30, unit: 'mcg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  VitaminB1: {\n    default: { max: 180, min: 70, optimalMax: 150, optimalMin: 80, unit: 'nmol/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  VitaminB12: {\n    default: { max: 900, min: 200, optimalMax: 800, optimalMin: 400, unit: 'pg/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  VitaminB6: {\n    default: { max: 50, min: 5, optimalMax: 40, optimalMin: 10, unit: 'ng/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  VitaminC: {\n    default: { max: 2.0, min: 0.4, optimalMax: 1.5, optimalMin: 0.6, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // Vitamina D — posicionamento conjunto SBEM/SBPC-ML 2017:\n  // ≥20 ng/mL é desejável para população saudável <60 anos\n  // ≥30 ng/mL é recomendado para grupos de risco (idosos, gestantes, DRC,\n  // osteoporose, hiperparatireoidismo secundário).\n  // A variante ageMin=60 cobre idosos. Gestação, doença renal crônica,\n  // osteoporose e hiperparatireoidismo secundário também exigem min=30;\n  // o tipo `BiomarkerReferenceRange` atual não expressa esses contextos\n  // clínicos além de gestação e idade, portanto consumidores devem aplicar\n  // o limiar ≥30 nessas populações quando souberem a comorbidade. Gestação\n  // será modelada quando `pregnant: true` — aceita-se TODO até lá.\n  // TODO(PR-vitd-pregnancy): adicionar variante `pregnant: true` com min=30\n  // quando a modelagem de comorbidades chegar ao schema.\n  VitaminD: {\n    default: { max: 100, min: 20, optimalMax: 70, optimalMin: 40, unit: 'ng/mL' },\n    source: 'ferreira-vitd-2017',\n    variants: [\n      {\n        ageMin: 60,\n        range: { max: 100, min: 30, optimalMax: 70, optimalMin: 40, unit: 'ng/mL' },\n        sex: 'all',\n      },\n    ],\n  },\n\n  VitaminD_1_25: {\n    default: { max: 72, min: 18, optimalMax: 60, optimalMin: 25, unit: 'pg/mL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  VitaminE: {\n    default: { max: 17, min: 5.5, optimalMax: 14, optimalMin: 7, unit: 'mg/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // VLDL — estimado clinicamente via TG/5 (método Friedewald). O corte de\n  // referência deriva de triglicérides <150 mg/dL (SBC 2025, dislipidemias),\n  // portanto VLDL <30. Friedewald-1972 permanece registrada como fonte do\n  // método de cálculo, mas a faixa de referência tem respaldo na diretriz\n  // SBC 2025.\n  VLDL: {\n    default: { max: 30, min: 2, optimalMax: 20, optimalMin: 5, unit: 'mg/dL' },\n    source: 'sbc-lipids-2025',\n  },\n\n  WBC: {\n    default: { max: 11.0, min: 4.0, optimalMax: 8.0, optimalMin: 5.0, unit: 'K/uL' },\n    source: 'pns-hemograma-2019',\n  },\n\n  Zinc: {\n    default: { max: 120, min: 60, optimalMax: 100, optimalMin: 70, unit: 'mcg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  AndroidFatPct: {\n    default: { max: 35, min: 10, optimalMax: 25, optimalMin: 15, unit: '%' },\n    direction: 'lower-better',\n    source: 'kelly-dxa-2009',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 30, min: 10, optimalMax: 22, optimalMin: 12, unit: '%' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 42, min: 15, optimalMax: 32, optimalMin: 20, unit: '%' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  AndroidGynoidRatio: {\n    default: { max: 1.2, min: 0.5, optimalMax: 1.0, optimalMin: 0.6, unit: '' },\n    direction: 'lower-better',\n    source: 'kelly-dxa-2009',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 1.2, min: 0.6, optimalMax: 1.0, optimalMin: 0.7, unit: '' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 1.0, min: 0.4, optimalMax: 0.8, optimalMin: 0.5, unit: '' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  BMC: {\n    default: { max: 3.5, min: 2.0, optimalMax: 3.2, optimalMin: 2.3, unit: 'kg' },\n    direction: 'higher-better',\n    source: 'kelly-dxa-2009',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 4.0, min: 2.5, optimalMax: 3.5, optimalMin: 2.8, unit: 'kg' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 3.0, min: 1.8, optimalMax: 2.7, optimalMin: 2.0, unit: 'kg' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  // BodyFatPct — Age-bracketed ranges from Gallagher et al. Am J Clin Nutr 2000;72:694-701\n  // (PMID: 10966886) and ACSM Guidelines for Exercise Testing, 11th Ed (2021)\n  BodyFatPct: {\n    default: { max: 30, min: 10, optimalMax: 25, optimalMin: 15, unit: '%' },\n    direction: 'lower-better',\n    source: 'gallagher-bodyfat-2000',\n    variants: [\n      // Men — age brackets\n      {\n        ageMax: 25,\n        ageMin: 18,\n        range: { max: 25, min: 5, optimalMax: 20, optimalMin: 10, unit: '%' },\n        sex: 'M',\n      },\n      {\n        ageMax: 35,\n        ageMin: 26,\n        range: { max: 26, min: 5, optimalMax: 21, optimalMin: 11, unit: '%' },\n        sex: 'M',\n      },\n      {\n        ageMax: 45,\n        ageMin: 36,\n        range: { max: 27, min: 5, optimalMax: 22, optimalMin: 12, unit: '%' },\n        sex: 'M',\n      },\n      {\n        ageMax: 55,\n        ageMin: 46,\n        range: { max: 28, min: 5, optimalMax: 23, optimalMin: 13, unit: '%' },\n        sex: 'M',\n      },\n      {\n        ageMin: 56,\n        range: { max: 29, min: 5, optimalMax: 24, optimalMin: 14, unit: '%' },\n        sex: 'M',\n      },\n      // Women — age brackets\n      {\n        ageMax: 25,\n        ageMin: 18,\n        range: { max: 32, min: 13, optimalMax: 28, optimalMin: 18, unit: '%' },\n        sex: 'F',\n      },\n      {\n        ageMax: 35,\n        ageMin: 26,\n        range: { max: 33, min: 13, optimalMax: 29, optimalMin: 18, unit: '%' },\n        sex: 'F',\n      },\n      {\n        ageMax: 45,\n        ageMin: 36,\n        range: { max: 34, min: 13, optimalMax: 30, optimalMin: 19, unit: '%' },\n        sex: 'F',\n      },\n      {\n        ageMax: 55,\n        ageMin: 46,\n        range: { max: 35, min: 13, optimalMax: 31, optimalMin: 20, unit: '%' },\n        sex: 'F',\n      },\n      {\n        ageMin: 56,\n        range: { max: 36, min: 13, optimalMax: 32, optimalMin: 20, unit: '%' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  FatFreeMass: {\n    default: { max: 80, min: 40, optimalMax: 70, optimalMin: 45, unit: 'kg' },\n    direction: 'higher-better',\n    source: 'kelly-dxa-2009',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 90, min: 50, optimalMax: 80, optimalMin: 55, unit: 'kg' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 60, min: 35, optimalMax: 52, optimalMin: 38, unit: 'kg' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  FatMass: {\n    default: { max: 30, min: 5, optimalMax: 20, optimalMin: 8, unit: 'kg' },\n    direction: 'lower-better',\n    source: 'kelly-dxa-2009',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 25, min: 5, optimalMax: 18, optimalMin: 7, unit: 'kg' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 30, min: 8, optimalMax: 22, optimalMin: 10, unit: 'kg' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  GynoidFatPct: {\n    default: { max: 45, min: 15, optimalMax: 35, optimalMin: 20, unit: '%' },\n    direction: 'lower-better',\n    source: 'kelly-dxa-2009',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 35, min: 12, optimalMax: 28, optimalMin: 15, unit: '%' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 50, min: 20, optimalMax: 40, optimalMin: 25, unit: '%' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  LeanMass: {\n    default: { max: 75, min: 35, optimalMax: 65, optimalMin: 40, unit: 'kg' },\n    direction: 'higher-better',\n    source: 'kelly-dxa-2009',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 85, min: 45, optimalMax: 75, optimalMin: 50, unit: 'kg' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 55, min: 30, optimalMax: 48, optimalMin: 35, unit: 'kg' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  TotalMass: {\n    default: { max: 100, min: 50, optimalMax: 85, optimalMin: 55, unit: 'kg' },\n    source: 'kelly-dxa-2009',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 100, min: 55, optimalMax: 90, optimalMin: 60, unit: 'kg' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 85, min: 45, optimalMax: 75, optimalMin: 50, unit: 'kg' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  VATMass: {\n    default: { max: 1.5, min: 0, optimalMax: 0.8, optimalMin: 0, unit: 'kg' },\n    direction: 'lower-better',\n    source: 'ofenheimer-vat-2020',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 1.5, min: 0, optimalMax: 1.0, optimalMin: 0, unit: 'kg' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 1.0, min: 0, optimalMax: 0.5, optimalMin: 0, unit: 'kg' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  VATVolume: {\n    default: {\n      max: 852,\n      min: 0,\n      optimalMax: 600,\n      optimalMin: 0,\n      unit: 'cm³',\n      warningMax: 1837,\n    },\n    direction: 'lower-better',\n    source: 'ge-corescan',\n  },\n\n  BMD_Total: {\n    default: { max: 1.4, min: 0.9, optimalMax: 1.3, optimalMin: 1.0, unit: 'g/cm²' },\n    direction: 'higher-better',\n    source: 'who-osteoporosis-1994',\n  },\n\n  TScore_Total: {\n    default: { max: 4.0, min: -1.0, optimalMax: 2.0, optimalMin: -0.5, unit: '' },\n    direction: 'higher-better',\n    source: 'who-osteoporosis-1994',\n  },\n\n  ZScore_Total: {\n    default: { max: 2.0, min: -2.0, optimalMax: 1.0, optimalMin: -1.0, unit: '' },\n    direction: 'higher-better',\n    source: 'who-osteoporosis-1994',\n  },\n\n  Amylase: {\n    default: { max: 100, min: 28, optimalMax: 90, optimalMin: 35, unit: 'U/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Creatinine_Urine: {\n    default: { max: 300, min: 20, optimalMax: 250, optimalMin: 40, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 300, min: 40, optimalMax: 260, optimalMin: 60, unit: 'mg/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 220, min: 20, optimalMax: 180, optimalMin: 40, unit: 'mg/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  IgA: {\n    default: { max: 400, min: 70, optimalMax: 350, optimalMin: 100, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Lipase: {\n    default: { max: 60, min: 0, optimalMax: 50, optimalMin: 10, unit: 'U/L' },\n    source: 'tietz-7ed-2015',\n  },\n\n  Microalbumin_Urine: {\n    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: 'mg/L' },\n    source: 'kdigo-ckd-2024',\n  },\n\n  PSA_Free: {\n    default: { max: 1.5, min: 0, optimalMax: 1.0, optimalMin: 0, unit: 'ng/mL' },\n    source: 'sturgeon-nacb-2008',\n  },\n\n  // Relação PSA livre/total — `higher-better`: razão maior = menor risco de\n  // câncer de próstata, logo não há limite superior \"ruim\" (acima do normal é\n  // verde). Faixas alinhadas à tabela clínica: ≥25% baixo risco (verde),\n  // 10–25% atenção — intermediário/moderado (âmbar), <10% alto risco >50%\n  // (vermelho). Limites: `min` (25) é o piso do verde e `warningMin` (10) o\n  // piso do âmbar — o vermelho é estritamente abaixo de 10% (< 10%); 10%\n  // pertence ao âmbar, conforme a faixa \"10–15% moderado\" da tabela.\n  PSA_FreeRatio: {\n    default: { max: 100, min: 25, optimalMax: 100, optimalMin: 30, unit: '%', warningMin: 10 },\n    direction: 'higher-better',\n    source: 'sturgeon-nacb-2008',\n  },\n\n  // BMI - WHO classification: 18.5–24.9 normal, 25–29.9 overweight, ≥30 obese\n  BMI: {\n    default: { max: 30, min: 18.5, optimalMax: 24.9, optimalMin: 18.5, unit: 'kg/m2' },\n    source: 'who-obesity-2000',\n  },\n\n  // eAG — Estimated Average Glucose, derivada da HbA1c pela fórmula ADAG:\n  // eAG (mg/dL) = 28,7 × HbA1c(%) − 46,7 (NATHAN, D. M. et al. Translating the\n  // A1C assay into estimated average glucose values. Diabetes Care, v. 31, n. 8,\n  // p. 1473-1478, 2008. DOI: 10.2337/dc08-0545).\n  //\n  // As faixas espelham os cortes diagnósticos de HbA1c da SBD (ver entrada\n  // `HbA1c`) convertidos por essa fórmula, mantendo a eAG coerente com o\n  // marcador de origem:\n  //   optimalMax 105  ← HbA1c 5,3 % (teto do controle ótimo)\n  //   max        117  ← HbA1c 5,7 % (teto do não diabético → início do pré-diabetes)\n  //   warningMax 137  ← HbA1c 6,4 % (teto do pré-diabetes → acima disso, diabetes)\n  //   optimalMin  82  ← HbA1c 4,5 % (piso do alvo fisiológico da entrada HbA1c)\n  //   min         11  ← HbA1c 2,0 % (mesmo piso de sanidade da entrada HbA1c)\n  //\n  // O piso era 70 nos dois campos, e não vinha desta conversão: 70 é o limite\n  // inferior clássico da glicemia **de jejum**, transplantado para uma média\n  // estimada de ~3 meses. Pela fórmula, 70 equivale a HbA1c 4,07 % — ou seja,\n  // marcava como alterado exatamente quem a entrada `HbA1c` documenta que não\n  // deve ser sinalizado, já que HbA1c baixa reflete hemólise, perda sanguínea\n  // ou hemoglobinopatia, e não doença do metabolismo glicêmico. Espelhar o piso\n  // do HbA1c mantém as duas entradas coerentes, que é o que o comentário sempre\n  // afirmou fazer.\n  //\n  // Substitui a faixa anterior (optimalMax 126 = corte de glicemia de jejum;\n  // max 154 = meta terapêutica do diabético, HbA1c 7 %), que classificava como\n  // \"Normal\" valores já pré-diabéticos e diabéticos.\n  eAG: {\n    default: { max: 117, min: 11, optimalMax: 105, optimalMin: 82, unit: 'mg/dL', warningMax: 137 },\n    source: 'sbd-diabetes-2024',\n  },\n\n  // INR - International Normalized Ratio (non-anticoagulated patients)\n  INR: {\n    default: { max: 1.2, min: 0.8, optimalMax: 1.1, optimalMin: 0.9, unit: 'ratio' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // Prothrombin Time\n  ProthrombinTime: {\n    default: { max: 13.5, min: 11, optimalMax: 13, optimalMin: 11, unit: 'seconds' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // DHT - Dihydrotestosterone (adult male reference; female values are much lower)\n  DHT: {\n    default: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: 'ng/dL' },\n    source: 'tietz-7ed-2015',\n    variants: [\n      {\n        ageMin: 18,\n        range: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: 'ng/dL' },\n        sex: 'M',\n      },\n      {\n        ageMin: 18,\n        range: { max: 22, min: 4, optimalMax: 22, optimalMin: 4, unit: 'ng/dL' },\n        sex: 'F',\n      },\n    ],\n  },\n\n  // Total IgE - higher values suggest atopy/allergic sensitization\n  IgE_Total: {\n    default: { max: 100, min: 0, optimalMax: 100, optimalMin: 0, unit: 'IU/mL' },\n    direction: 'lower-better',\n    source: 'tietz-7ed-2015',\n  },\n\n  // IgG - Immunoglobulin G\n  IgG: {\n    default: { max: 1600, min: 700, optimalMax: 1600, optimalMin: 700, unit: 'mg/dL' },\n    source: 'tietz-7ed-2015',\n  },\n\n  // IgE E1 Cat Dander - Class 0 (≤0.35 kU/L) = negative\n  IgE_E1_CatDander: {\n    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: 'kU/L' },\n    direction: 'lower-better',\n    source: 'tietz-7ed-2015',\n  },\n\n  // IgE GX1 Grasses - Class 0 (≤0.35 kU/L) = negative\n  IgE_GX1_Grasses: {\n    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: 'kU/L' },\n    direction: 'lower-better',\n    source: 'tietz-7ed-2015',\n  },\n};\n\n// =============================================================================\n// HELPER FUNCTIONS\n// =============================================================================\n\n/**\n * Legacy flat reference ranges for backward compatibility\n * This is derived from biomarkerRangeDefinitions defaults\n */\nexport const defaultReferenceRanges: Record<string, BiomarkerReferenceRange> = Object.fromEntries(\n  Object.entries(biomarkerRangeDefinitions).map(([code, def]) => [\n    code,\n    def.source ? { ...def.default, source: def.source } : def.default,\n  ]),\n);\n\n/**\n * Get the reference range for a biomarker code, optionally personalized for user context\n * @param testCode - The biomarker code (e.g., \"HDL\", \"Testosterone\")\n * @param context - Optional user context for personalized ranges\n * @returns Reference range or undefined if not found\n */\nexport function getReferenceRange(\n  testCode: string,\n  context?: ReferenceRangeContext,\n): BiomarkerReferenceRange | undefined {\n  const definition = biomarkerRangeDefinitions[testCode];\n  if (!definition) return undefined;\n\n  const withSource = (range: BiomarkerReferenceRange): BiomarkerReferenceRange =>\n    definition.source ? { ...range, source: definition.source } : range;\n\n  // If no context or no variants, return default\n  if (!context || !definition.variants || definition.variants.length === 0) {\n    return withSource(definition.default);\n  }\n\n  const { age, biologicalSex, pregnancyTrimester, pregnant } = context;\n\n  // Detect whether the biomarker has pregnancy-specific variants at all.\n  // Se o biomarcador não modela gestação, uma usuária gestante deve continuar\n  // recebendo a variante por sexo/idade (mais informativa que o default). Apenas\n  // quando existe ao menos uma variante gestacional é que bloqueamos as variantes\n  // não-gestacionais para contextos gestantes — evitando mistura de faixas.\n  //\n  // Precedência quando pregnant=true: variantes gestacionais têm precedência\n  // absoluta sobre variantes etárias. Uma gestante de 65+ anos consultando\n  // TSH recebe a faixa gestacional, não a variante ageMin=65. Isto é\n  // intencional — em gestação, o eixo HPG domina sobre o envelhecimento\n  // fisiológico. Casos raros de gestação pós-menopausa (FIV) seguem essa\n  // regra; o consumidor que precise distinguir deve aplicar lógica de\n  // contexto adicional.\n  //\n  // Tratamento de `pregnant: undefined` vs `false`: ambos são tratados como\n  // \"não-gestante\" (fallback seguro). O consumidor deve setar pregnant: true\n  // explicitamente para ativar variantes gestacionais; contexto sem a flag\n  // recebe a faixa padrão da população geral.\n  const hasPregnancyVariant = definition.variants.some((v) => v.pregnant === true);\n\n  // Find matching variant (first match wins — more specific variants must be\n  // listed first). Ordem obrigatória quando há variantes gestacionais:\n  //   1. variantes trimestre-específicas (pregnant=true + pregnancyTrimester=N)\n  //   2. catch-all gestacional (pregnant=true, sem trimester)\n  //   3. variantes por sexo/idade não-gestacionais\n  // Reordenar quebraria o matching; a verificação `variant.pregnancyTrimester\n  // !== pregnancyTrimester` depende da catch-all vir por último.\n  for (const variant of definition.variants) {\n    if (variant.pregnant === true) {\n      if (!pregnant) continue;\n      // Variante com trimestre específico só casa quando o contexto também\n      // especifica o mesmo trimestre. Variantes gestacionais sem trimestre\n      // (catch-all) casam com qualquer contexto gestante, servindo de fallback.\n      if (\n        variant.pregnancyTrimester !== undefined &&\n        variant.pregnancyTrimester !== pregnancyTrimester\n      ) {\n        continue;\n      }\n    } else if (pregnant && hasPregnancyVariant) {\n      // Só pulamos variantes não-gestacionais se o biomarcador tem variantes\n      // gestacionais; caso contrário, a variante por sexo/idade é aplicável.\n      continue;\n    }\n\n    // Check sex match ('all' matches everyone)\n    if (variant.sex !== 'all' && variant.sex !== biologicalSex) {\n      continue;\n    }\n\n    // Check age range\n    if (variant.ageMin !== undefined && (age === undefined || age < variant.ageMin)) {\n      continue;\n    }\n    if (variant.ageMax !== undefined && (age === undefined || age > variant.ageMax)) {\n      continue;\n    }\n\n    return withSource(variant.range);\n  }\n\n  // No matching variant found - return default\n  return withSource(definition.default);\n}\n\n/**\n * Get the range direction for a biomarker code.\n * Returns 'range' (default) if not specified.\n */\nexport function getRangeDirection(testCode: string): RangeDirection {\n  return biomarkerRangeDefinitions[testCode]?.direction ?? 'range';\n}\n\n/**\n * Get fallback reference range for a biomarker code (default only, no personalization)\n * Used by API when LLM doesn't extract reference values\n * @param biomarkerCode - The biomarker code\n * @returns Reference range with min/max/unit or undefined\n */\nexport function getFallbackReferenceRange(\n  biomarkerCode: string,\n): { min: number; max: number; unit: string } | undefined {\n  const definition = biomarkerRangeDefinitions[biomarkerCode];\n  if (!definition || definition.default.min === undefined || definition.default.max === undefined) {\n    return undefined;\n  }\n  return {\n    max: definition.default.max,\n    min: definition.default.min,\n    unit: definition.default.unit,\n  };\n}\n\n/**\n * Apply fallback reference ranges to biomarkers that are missing them\n * @param biomarkers - Array of parsed biomarkers\n * @returns Count of biomarkers that received fallback references\n */\nexport function applyFallbackReferenceRanges<\n  T extends {\n    code: string;\n    referenceMin?: number | null;\n    referenceMax?: number | null;\n    unit?: string;\n  },\n>(biomarkers: T[]): number {\n  let fallbackCount = 0;\n\n  for (const biomarker of biomarkers) {\n    // Skip if already has reference values\n    if (biomarker.referenceMin != null && biomarker.referenceMax != null) {\n      continue;\n    }\n\n    const fallback = getFallbackReferenceRange(biomarker.code);\n    if (fallback) {\n      // Only apply if units are compatible or biomarker has no unit\n      const canonicalUnit = getCanonicalUnitForCode(biomarker.code);\n      const unitsMatch =\n        !biomarker.unit ||\n        biomarker.unit.toLowerCase() === fallback.unit.toLowerCase() ||\n        (canonicalUnit && biomarker.unit.toLowerCase() === canonicalUnit.toLowerCase()) ||\n        // Handle common unit variations\n        (biomarker.unit === '%' && fallback.unit === '%');\n\n      if (unitsMatch) {\n        if (biomarker.referenceMin == null) {\n          biomarker.referenceMin = fallback.min;\n        }\n        if (biomarker.referenceMax == null) {\n          biomarker.referenceMax = fallback.max;\n        }\n        fallbackCount++;\n      }\n    }\n  }\n\n  return fallbackCount;\n}\n"]}

package/dist/cli.js

@@ -1454,7 +1454,7 @@ var BIOMARKER_DEFINITIONS = [
       en: ["International Normalized Ratio", "INR"],
       pt: ["Raz\xE3o Normalizada Internacional", "INR", "RNI"]
     },
-    unit: "ratio"
+    unit: "raz\xE3o"
   },
   {
     category: "sangue",
@@ -1465,7 +1465,7 @@ var BIOMARKER_DEFINITIONS = [
       en: ["Prothrombin Time", "PT", "Pro Time"],
       pt: ["Tempo de Protrombina", "TP", "TAP"]
     },
-    unit: "seconds"
+    unit: "segundos"
   },
   {
     category: "sangue",
@@ -2151,7 +2151,7 @@ var BIOMARKER_DEFINITIONS = [
         "\xCDndice Androide/Ginoide"
       ]
     },
-    unit: "ratio"
+    unit: "raz\xE3o"
   },
   {
     category: "composicao-corporal",
@@ -4588,15 +4588,12 @@ var biomarkerRangeDefinitions = {
     source: "harris-omega3-2004"
   },
   eGFR: {
-    default: { max: 120, min: 90, optimalMax: 120, optimalMin: 90, unit: "mL/min/1.73m\xB2" },
-    source: "kdigo-ckd-2024",
-    variants: [
-      {
-        ageMin: 60,
-        range: { max: 90, min: 60, optimalMax: 90, optimalMin: 60, unit: "mL/min/1.73m\xB2" },
-        sex: "all"
-      }
-    ]
+    default: { max: 120, min: 60, optimalMax: 120, optimalMin: 90, unit: "mL/min/1.73m\xB2" },
+    // KDIGO 2024: TFG 60-89 (G2) sem marcador de lesão renal não é DRC, em
+    // nenhuma faixa etária. A variante por idade que existia aqui rebaixava o
+    // piso só para 60+ e ainda limitava o teto a 90, o que sinalizava como
+    // alterado qualquer idoso com função preservada.
+    source: "kdigo-ckd-2024"
   },
   Eosinophils: {
     default: { max: 5, min: 0, optimalMax: 4, optimalMin: 1, unit: "%" },
@@ -4913,7 +4910,7 @@ var biomarkerRangeDefinitions = {
       min: 2,
       optimalMax: 8,
       optimalMin: 3,
-      unit: "\xB5IU/mL"
+      unit: "uIU/mL"
     },
     source: "tietz-7ed-2015"
   },
@@ -4982,7 +4979,7 @@ var biomarkerRangeDefinitions = {
   LDL_Peak_Size: {
     // LDL Peak Size: higher is better (larger particles less atherogenic)
     // Quest Ion Mobility reference: optimal >222.9 Å (22.29 nm)
-    default: { max: 250, min: 217.4, optimalMax: 250, optimalMin: 222.9, unit: "\xC5" },
+    default: { max: 250, min: 217.4, optimalMax: 250, optimalMin: 222.9, unit: "Angstrom" },
     direction: "higher-better",
     source: "caulfield-ionmobility-2008"
   },
@@ -5447,7 +5444,7 @@ var biomarkerRangeDefinitions = {
   // sem invadir a faixa subclínica. Variante ageMin=65 mantém limite superior
   // expandido (tolerância fisiológica do eixo em idosos, SBEM 2013).
   TSH: {
-    default: { max: 4, min: 0.4, optimalMax: 3, optimalMin: 1, unit: "\xB5IU/mL" },
+    default: { max: 4, min: 0.4, optimalMax: 3, optimalMin: 1, unit: "uIU/mL" },
     source: "sbem-thyroid-2013",
     variants: [
       // Variantes gestacionais (ATA 2017 / SBEM): supressão fisiológica por hCG
@@ -5460,31 +5457,31 @@ var biomarkerRangeDefinitions = {
       {
         pregnant: true,
         pregnancyTrimester: 1,
-        range: { max: 2.5, min: 0.1, optimalMax: 2, optimalMin: 0.5, unit: "\xB5IU/mL" },
+        range: { max: 2.5, min: 0.1, optimalMax: 2, optimalMin: 0.5, unit: "uIU/mL" },
         sex: "F"
       },
       {
         pregnant: true,
         pregnancyTrimester: 2,
-        range: { max: 3, min: 0.2, optimalMax: 2.5, optimalMin: 0.5, unit: "\xB5IU/mL" },
+        range: { max: 3, min: 0.2, optimalMax: 2.5, optimalMin: 0.5, unit: "uIU/mL" },
         sex: "F"
       },
       {
         pregnant: true,
         pregnancyTrimester: 3,
-        range: { max: 3, min: 0.3, optimalMax: 2.5, optimalMin: 0.5, unit: "\xB5IU/mL" },
+        range: { max: 3, min: 0.3, optimalMax: 2.5, optimalMin: 0.5, unit: "uIU/mL" },
         sex: "F"
       },
       // Catch-all gestacional — usada quando o trimestre não é informado.
       // Adota a faixa mais conservadora (2º/3º trimestre: 0.2–3.0).
       {
         pregnant: true,
-        range: { max: 3, min: 0.2, optimalMax: 2.5, optimalMin: 0.5, unit: "\xB5IU/mL" },
+        range: { max: 3, min: 0.2, optimalMax: 2.5, optimalMin: 0.5, unit: "uIU/mL" },
         sex: "F"
       },
       {
         ageMin: 65,
-        range: { max: 6, min: 0.4, optimalMax: 4, optimalMin: 1, unit: "\xB5IU/mL" },
+        range: { max: 6, min: 0.4, optimalMax: 4, optimalMin: 1, unit: "uIU/mL" },
         sex: "all"
       }
     ]
@@ -5922,12 +5919,23 @@ var biomarkerRangeDefinitions = {
   //   optimalMax 105  ← HbA1c 5,3 % (teto do controle ótimo)
   //   max        117  ← HbA1c 5,7 % (teto do não diabético → início do pré-diabetes)
   //   warningMax 137  ← HbA1c 6,4 % (teto do pré-diabetes → acima disso, diabetes)
+  //   optimalMin  82  ← HbA1c 4,5 % (piso do alvo fisiológico da entrada HbA1c)
+  //   min         11  ← HbA1c 2,0 % (mesmo piso de sanidade da entrada HbA1c)
+  //
+  // O piso era 70 nos dois campos, e não vinha desta conversão: 70 é o limite
+  // inferior clássico da glicemia **de jejum**, transplantado para uma média
+  // estimada de ~3 meses. Pela fórmula, 70 equivale a HbA1c 4,07 % — ou seja,
+  // marcava como alterado exatamente quem a entrada `HbA1c` documenta que não
+  // deve ser sinalizado, já que HbA1c baixa reflete hemólise, perda sanguínea
+  // ou hemoglobinopatia, e não doença do metabolismo glicêmico. Espelhar o piso
+  // do HbA1c mantém as duas entradas coerentes, que é o que o comentário sempre
+  // afirmou fazer.
   //
   // Substitui a faixa anterior (optimalMax 126 = corte de glicemia de jejum;
   // max 154 = meta terapêutica do diabético, HbA1c 7 %), que classificava como
   // "Normal" valores já pré-diabéticos e diabéticos.
   eAG: {
-    default: { max: 117, min: 70, optimalMax: 105, optimalMin: 70, unit: "mg/dL", warningMax: 137 },
+    default: { max: 117, min: 11, optimalMax: 105, optimalMin: 82, unit: "mg/dL", warningMax: 137 },
     source: "sbd-diabetes-2024"
   },
   // INR - International Normalized Ratio (non-anticoagulated patients)
@@ -6165,7 +6173,7 @@ async function main() {
     strict: false
   });
   if (values.version) {
-    process.stdout.write(`${"0.16.3"}
+    process.stdout.write(`${"0.16.5"}
 `);
     return;
   }

package/dist/converter.cjs

@@ -3,13 +3,13 @@
 
 
 
-var _chunkQ3O23BM7cjs = require('./chunk-Q3O23BM7.cjs');
-require('./chunk-3NZA6WMU.cjs');
+var _chunkSLTDA7DXcjs = require('./chunk-SLTDA7DX.cjs');
+require('./chunk-73PI5ZLR.cjs');
 require('./chunk-MJ254F5K.cjs');
 
 
 
 
 
-exports.labObservationToFHIR = _chunkQ3O23BM7cjs.labObservationToFHIR; exports.labReportToFHIR = _chunkQ3O23BM7cjs.labReportToFHIR; exports.labResultToFHIRBundle = _chunkQ3O23BM7cjs.labResultToFHIRBundle; exports.userProfileToFHIR = _chunkQ3O23BM7cjs.userProfileToFHIR;
+exports.labObservationToFHIR = _chunkSLTDA7DXcjs.labObservationToFHIR; exports.labReportToFHIR = _chunkSLTDA7DXcjs.labReportToFHIR; exports.labResultToFHIRBundle = _chunkSLTDA7DXcjs.labResultToFHIRBundle; exports.userProfileToFHIR = _chunkSLTDA7DXcjs.userProfileToFHIR;
 //# sourceMappingURL=converter.cjs.map

package/dist/converter.js

@@ -3,8 +3,8 @@ import {
   labReportToFHIR,
   labResultToFHIRBundle,
   userProfileToFHIR
-} from "./chunk-5BDMX2JP.js";
-import "./chunk-FEVGNEFO.js";
+} from "./chunk-NFTHC3ZR.js";
+import "./chunk-NMF7MNOP.js";
 import "./chunk-R4MUCMO3.js";
 export {
   labObservationToFHIR,

package/dist/importer.cjs

@@ -4,8 +4,8 @@
 
 
 
-var _chunkY2SVZ6GEcjs = require('./chunk-Y2SVZ6GE.cjs');
-require('./chunk-3NZA6WMU.cjs');
+var _chunkN5BYRLCCcjs = require('./chunk-N5BYRLCC.cjs');
+require('./chunk-73PI5ZLR.cjs');
 require('./chunk-3ILBFLVQ.cjs');
 
 
@@ -13,5 +13,5 @@ require('./chunk-3ILBFLVQ.cjs');
 
 
 
-exports.MAX_FILE_SIZE = _chunkY2SVZ6GEcjs.MAX_FILE_SIZE; exports.MAX_OBSERVATIONS = _chunkY2SVZ6GEcjs.MAX_OBSERVATIONS; exports.extractObservationsFromBundle = _chunkY2SVZ6GEcjs.extractObservationsFromBundle; exports.mapFHIRObservationToInternal = _chunkY2SVZ6GEcjs.mapFHIRObservationToInternal; exports.processImportBundle = _chunkY2SVZ6GEcjs.processImportBundle;
+exports.MAX_FILE_SIZE = _chunkN5BYRLCCcjs.MAX_FILE_SIZE; exports.MAX_OBSERVATIONS = _chunkN5BYRLCCcjs.MAX_OBSERVATIONS; exports.extractObservationsFromBundle = _chunkN5BYRLCCcjs.extractObservationsFromBundle; exports.mapFHIRObservationToInternal = _chunkN5BYRLCCcjs.mapFHIRObservationToInternal; exports.processImportBundle = _chunkN5BYRLCCcjs.processImportBundle;
 //# sourceMappingURL=importer.cjs.map

package/dist/importer.js

@@ -4,8 +4,8 @@ import {
   extractObservationsFromBundle,
   mapFHIRObservationToInternal,
   processImportBundle
-} from "./chunk-4I5G4SJ6.js";
-import "./chunk-FEVGNEFO.js";
+} from "./chunk-UHF354DX.js";
+import "./chunk-NMF7MNOP.js";
 import "./chunk-N3ZCOLG2.js";
 export {
   MAX_FILE_SIZE,