@precisa-saude/fhir 0.32.0 → 0.34.0

package/dist/cli.js

@@ -124,6 +124,10 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "coracao",
     code: "LDL_Medium",
+    // 96735-6 é "in Serum" só, enquanto as vizinhas LDL_Small (43727-7),
+    // LDL_ParticleNumber (54434-6) e HDL_Large (43729-3) são Ser/Plas. É o
+    // único código para a subfração média, e o perfil por RMN roda em soro.
+    // Material registrado de propósito.
     loinc: "96735-6",
     names: {
       en: ["LDL Medium", "Medium LDL Particles"],
@@ -1091,14 +1095,16 @@ var BIOMARKER_DEFINITIONS = [
   },
   {
     // LOINC 99620-7 = "Omega 3 fatty acids (w3) [Moles/volume] in RBC.lysate".
-    // Alinha à matriz das entradas irmãs Omega3_EPA (75097-6) e Omega3_DHA
-    // (75095-0), ambas em hemácias. Anteriormente 35178-3 (mesmo analito em
-    // Ser/Plas), incompatível com o uso clínico do Índice Ômega-3 (Harris &
-    // von Schacky 2004), que é definido em membranas de hemácias.
-    // Ressalva: LOINC declara moles/volume; o biomarcador armazena %.
-    // Não há LOINC vigente para "Omega 3 total em % em RBC" — o `Omega3_Index`
-    // (88998-0) cobre apenas EPA+DHA. Mantemos `unit: '%'` por consistência
-    // com EPA/DHA (75095-0/75097-6 são [Entitic substance], também não-%).
+    // Anteriormente 35178-3 (mesmo analito em Ser/Plas), incompatível com o
+    // uso clínico do Índice Ômega-3 (Harris & von Schacky 2004), que é
+    // definido em membranas de hemácias.
+    //
+    // Compromisso declarado, e não erro: o LOINC 2.82 não tem código de fração
+    // ("ômega-3 total / ácidos graxos totais") para o total, só para os ácidos
+    // individuais e para EPA+DPA+DHA (90911-9). O componente confere; a
+    // propriedade é moles/volume enquanto o laudo imprime %. O teste de eixos
+    // (`loinc-axes.test.ts`) lista esta entrada como exceção com este motivo.
+    // Mesmo compromisso em `Omega6_Total` (99621-5).
     category: "nutrientes",
     code: "Omega3_Total",
     loinc: "99620-7",
@@ -1112,7 +1118,18 @@ var BIOMARKER_DEFINITIONS = [
     category: "nutrientes",
     code: "Omega3_DHA",
     codeAliases: ["DHA"],
-    loinc: "75095-0",
+    // Ácidos graxos individuais: fração do total (% dos ácidos graxos C14-C22),
+    // que é o que o perfil de ácidos graxos e o Índice Ômega-3 imprimem. Os
+    // códigos vêm do painel 90918-4 ("Fatty acid omega-3 and omega-6 panel -
+    // Blood"), o mesmo de onde já saem as razões AA/EPA (90909-3) e ω6/ω3
+    // (90910-1). Até out/2026 apontavam para os códigos [Entitic substance]
+    // em hemácias (75095-0, 75097-6, 75110-7, 75117-2), que são quantidade por
+    // célula, e para 48371-9, que é moles/volume em soro: componente certo,
+    // propriedade errada nos cinco, desde mar/2026. Ficam como alias porque o
+    // analito é o mesmo. Material: o painel em soro/plasma (88884-2, C14-C24)
+    // existe, e é a troca a fazer se um laboratório imprimir o perfil em soro.
+    loinc: "90914-3",
+    loincAliases: ["75095-0"],
     names: {
       en: ["Omega-3 DHA", "DHA", "Docosahexaenoic Acid"],
       pt: ["\xD4mega-3: DHA", "DHA", "\xC1cido Docosahexaenoico"]
@@ -1123,7 +1140,9 @@ var BIOMARKER_DEFINITIONS = [
     category: "nutrientes",
     code: "Omega3_DPA",
     codeAliases: ["DPA"],
-    loinc: "48371-9",
+    // Fração em sangue, painel 90918-4. Ver `Omega3_DHA`.
+    loinc: "90913-5",
+    loincAliases: ["48371-9"],
     names: {
       en: ["Omega-3 DPA", "DPA", "Docosapentaenoic Acid"],
       pt: ["\xD4mega-3: DPA", "DPA", "\xC1cido Docosapentaenoico"]
@@ -1134,7 +1153,9 @@ var BIOMARKER_DEFINITIONS = [
     category: "nutrientes",
     code: "Omega3_EPA",
     codeAliases: ["EPA"],
-    loinc: "75097-6",
+    // Fração em sangue, painel 90918-4. Ver `Omega3_DHA`.
+    loinc: "90912-7",
+    loincAliases: ["75097-6"],
     names: {
       en: ["Omega-3 EPA", "EPA", "Eicosapentaenoic Acid"],
       pt: ["\xD4mega-3: EPA", "EPA", "\xC1cido Eicosapentaenoico"]
@@ -1144,7 +1165,12 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "nutrientes",
     code: "EPADPADHA",
-    loinc: "90908-5",
+    // 90911-9 é a fração EPA+DPA+DHA / ácidos graxos C14-C22 em sangue, o
+    // valor em %. Até out/2026 apontava para 90908-5, que é a *interpretação*
+    // desse mesmo valor (ordinal: risco alto, moderado, baixo), e não o
+    // número. Sem alias: código ordinal carregando valor numérico é o erro
+    // que se quer parar de aceitar.
+    loinc: "90911-9",
     names: {
       en: ["Omega-3 EPA+DPA+DHA", "EPA+DPA+DHA"],
       pt: ["\xD4mega-3: EPA+DPA+DHA"]
@@ -1165,7 +1191,12 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "nutrientes",
     code: "Omega6_Total",
-    loinc: "35177-5",
+    // 99621-5 é "Omega 6 fatty acids (w6) [Moles/volume] in RBC.lysate", o
+    // par exato do 99620-7 de `Omega3_Total`, com o mesmo compromisso de
+    // propriedade documentado lá. Até out/2026 apontava para 35177-5, que é
+    // ácidos graxos poli-insaturados totais em soro: ômega-3 e ômega-6
+    // somados, outro componente. Sem alias.
+    loinc: "99621-5",
     names: {
       en: ["Omega-6 Total", "Total Omega-6"],
       pt: ["\xD4mega-6 Total"]
@@ -1176,7 +1207,9 @@ var BIOMARKER_DEFINITIONS = [
     category: "nutrientes",
     code: "Omega6_AA",
     codeAliases: ["Arachidonic_Acid"],
-    loinc: "75110-7",
+    // Fração em sangue, painel 90918-4. Ver `Omega3_DHA`.
+    loinc: "90916-8",
+    loincAliases: ["75110-7"],
     names: {
       en: ["Omega-6 Arachidonic Acid", "Arachidonic Acid", "AA"],
       pt: ["\xD4mega-6: \xC1cido Araquid\xF4nico", "\xC1cido Araquid\xF4nico", "AA"]
@@ -1187,7 +1220,9 @@ var BIOMARKER_DEFINITIONS = [
     category: "nutrientes",
     code: "Omega6_LA",
     codeAliases: ["Linoleic_Acid"],
-    loinc: "75117-2",
+    // Fração em sangue, painel 90918-4. Ver `Omega3_DHA`.
+    loinc: "90917-6",
+    loincAliases: ["75117-2"],
     names: {
       en: ["Omega-6 Linoleic Acid", "Linoleic Acid", "LA"],
       pt: ["\xD4mega-6: \xC1cido Linoleico", "\xC1cido Linoleico", "LA"]
@@ -1268,7 +1303,11 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "nutrientes",
     code: "Zinc",
-    loinc: "8245-3",
+    // 5763-8 é "Zinc [Mass/volume] in Serum or Plasma", o zinco sérico da
+    // rotina brasileira (o nome em inglês já dizia "Serum Zinc"). Até out/2026
+    // apontava para 8245-3, o mesmo analito em sangue total, que tem faixa de
+    // referência própria. Sem alias: sangue total é outro material.
+    loinc: "5763-8",
     names: {
       en: ["Zinc", "Serum Zinc"],
       pt: ["Zinco"]
@@ -1369,6 +1408,9 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "figado",
     code: "Globulin",
+    // 2336-6 é "Globulin [Mass/volume] in Serum", soro só: o LOINC 2.82 não
+    // tem a versão Ser/Plas da globulina total (as frações alfa, beta e gama
+    // têm). Material registrado de propósito.
     loinc: "2336-6",
     names: {
       en: ["Globulin", "Serum Globulin"],
@@ -1648,6 +1690,13 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "rins",
     code: "BUN_Creatinine_Ratio",
+    // 3097-3 é "Urea nitrogen/Creatinine [Mass Ratio]", a razão BUN/creatinina,
+    // e a faixa de referência (10-20, Tietz) é a dessa convenção. O laudo
+    // brasileiro imprime "Relação Ureia/Creatinina", cuja faixa é outra (cerca
+    // de 21-43) e cujo código é 56997-0 ("Urea/Creatinine [Mass Ratio] in
+    // Serum or Plasma"). Trocar só o código deixaria a faixa errada do outro
+    // lado; a separação em duas grandezas, como em `Glucose_Fasting`, é
+    // decisão à parte, registrada em `reference-ranges.ts`.
     loinc: "3097-3",
     names: {
       en: ["BUN/Creatinine Ratio", "Urea/Creatinine Ratio"],
@@ -1815,7 +1864,12 @@ var BIOMARKER_DEFINITIONS = [
     category: "urina",
     code: "Bacteria_Urine",
     codeAliases: ["UrineBacteria"],
-    loinc: "630-4",
+    // 5769-5 é "Bacteria [#/area] in Urine sediment by Microscopy high power
+    // field", a contagem do sedimento que a unidade /HPF declara. Até out/2026
+    // apontava para 630-4, "Bacteria identified in Urine by Culture": outro
+    // exame, nominal, que identifica a espécie em cultura. Sem alias:
+    // urocultura não é sedimento.
+    loinc: "5769-5",
     names: {
       en: ["Urine Bacteria", "Bacteria Urine", "Bacteria, Urine", "Bacteria"],
       pt: ["Bact\xE9rias na Urina", "Bact\xE9rias"]
@@ -1934,7 +1988,14 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "urina",
     code: "RBC_Urine",
-    loinc: "5808-1",
+    // 13945-1 é "Erythrocytes [#/area] in Urine sediment by Microscopy high
+    // power field", o /HPF que o laudo imprime e que `Leukocytes_Urine` já usa
+    // em 5821-4. Até out/2026 apontava para 5808-1, o mesmo exame em #/volume
+    // (por mL): analito e material certos, propriedade errada. Fica como alias
+    // porque o analito é o mesmo, e laudo de analisador automático que conte
+    // por mL continua resolvendo em RBC_Urine.
+    loinc: "13945-1",
+    loincAliases: ["5808-1"],
     names: {
       en: ["Urine RBC", "Red Blood Cells in Urine", "RBC Urine", "RBC, Urine"],
       pt: ["Hem\xE1cias na Urina"]
@@ -2029,6 +2090,10 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "autoimunidade",
     code: "Gliadin_Deamidated_IgA",
+    // 63453-5 e 63459-2 (IgG) afirmam método, "by Immunoassay", e material,
+    // "Serum". É o que os kits de DGP usam. A propriedade é unidades
+    // arbitrárias por volume, e o laudo imprime U/mL; até out/2026 a unidade
+    // declarada era "U", sem o volume.
     loinc: "63453-5",
     names: {
       en: [
@@ -2042,7 +2107,7 @@ var BIOMARKER_DEFINITIONS = [
       ],
       pt: ["Anticorpos Anti-Gliadina Deamidada IgA", "DGP IgA"]
     },
-    unit: "U"
+    unit: "U/mL"
   },
   {
     category: "autoimunidade",
@@ -2060,7 +2125,7 @@ var BIOMARKER_DEFINITIONS = [
       ],
       pt: ["Anticorpos Anti-Gliadina Deamidada IgG", "DGP IgG"]
     },
-    unit: "U"
+    unit: "U/mL"
   },
   {
     category: "autoimunidade",
@@ -2451,6 +2516,10 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "composicao-corporal",
     code: "TotalBodyWater",
+    // 101683-1 é "Body water mass", em kg; o aparelho de bioimpedância imprime
+    // litros. É o único código de água corporal total no LOINC 2.82 (o outro,
+    // 101684-9, é o percentual), e para água 1 L pesa 1 kg, então o número não
+    // muda. O teste de eixos lista a entrada como exceção com este motivo.
     loinc: "101683-1",
     names: {
       en: ["Total Body Water", "Body Water", "TBW", "Total Water"],
@@ -2516,6 +2585,10 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "composicao-corporal",
     code: "PhaseAngle",
+    // 107160-4 é "Phase angle Xc/R [Ratio] Bioelectrical impedance analysis",
+    // único código de ângulo de fase. O aparelho imprime graus (arctan Xc/R)
+    // e o LOINC declara razão com unidade-exemplo %. Fica em graus, que é o
+    // que o laudo traz, e o teste de eixos lista a entrada como exceção.
     loinc: "107160-4",
     names: {
       en: ["Phase Angle", "Whole Body Phase Angle", "PhA", "AnglePhase"],
@@ -2606,9 +2679,9 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "composicao-corporal",
     code: "WaistCircumference",
-    // 8280-0 é a medida em si. 56086-2, que parecia o óbvio pela busca, é
-    // "Adult Waist Circumference Protocol", um protocolo PhenX e não um
-    // resultado.
+    // 8280-0 é a medida em si, e afirma sítio e método: "at umbilicus by Tape
+    // measure". 56086-2, que parecia o óbvio pela busca, é "Adult Waist
+    // Circumference Protocol", um protocolo PhenX e não um resultado.
     loinc: "8280-0",
     names: {
       en: ["Waist Circumference", "Abdominal Circumference", "Waist"],
@@ -3018,6 +3091,10 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "coracao",
     code: "TroponinI",
+    // 49563-0 afirma método: limite de detecção ≤ 0,01 ng/mL, o ensaio de alta
+    // sensibilidade. Um resultado de troponina I convencional pede o código
+    // sem método, 10839-9. Assimétrico com `TroponinT`, que fica no 6598-7 sem
+    // método de propósito: a hs-cTnT em ng/L é a convenção dos laudos.
     loinc: "49563-0",
     names: {
       en: ["Troponin I", "cTnI", "Cardiac Troponin I", "hs-TnI", "High-Sensitivity Troponin I"],
@@ -3028,6 +3105,9 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "coracao",
     code: "TroponinT",
+    // 6598-7 não afirma método. A unidade ng/L é a convenção do ensaio de alta
+    // sensibilidade (hs-cTnT), e o ensaio convencional em ng/mL converte por
+    // fator exato (ver `units.ts`). Ver `TroponinI` para a assimetria.
     loinc: "6598-7",
     names: {
       en: ["Troponin T", "cTnT", "Cardiac Troponin T", "hs-TnT", "High-Sensitivity Troponin T"],
@@ -3064,6 +3144,11 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "figado",
     code: "LDH",
+    // 14804-9 afirma método: reação lactato → piruvato (L→P). O código sem
+    // método, 2532-0, está DISCOURAGED, então um método tem que ser escolhido,
+    // e L→P é o do procedimento de referência IFCC que os laboratórios
+    // brasileiros usam, ainda que o laudo raramente imprima a direção. Se um
+    // laudo declarar P→L, o código é outro (14805-6).
     loinc: "14804-9",
     // 2532-0 é o código genérico anterior, que o LOINC marca como DISCOURAGED.
     // Fica como alias para que laudo antigo e dado já armazenado continuem
@@ -3194,7 +3279,13 @@ var BIOMARKER_DEFINITIONS = [
   {
     category: "pancreas",
     code: "BetaHydroxybutyrate",
-    loinc: "53060-0",
+    // 6873-4 é "Beta hydroxybutyrate [Moles/volume] in Serum or Plasma", o
+    // que o laudo dosa em mmol/L. Até out/2026 apontava para 53060-0, que é
+    // butirilcarnitina (C4) em líquido amniótico: analito e material errados
+    // desde abr/2026, e nenhum check pegou porque o código existe e está
+    // ACTIVE. Sem alias para o código antigo: ele nunca significou BHB, e
+    // aceitá-lo na importação faria um laudo de carnitina virar cetona.
+    loinc: "6873-4",
     names: {
       en: ["Beta-Hydroxybutyrate", "\u03B2-Hydroxybutyrate", "BHB", "Ketone Bodies"],
       pt: ["Beta-Hidroxibutirato", "\u03B2-Hidroxibutirato", "BHB", "Corpos Cet\xF4nicos"]
@@ -3325,97 +3416,99 @@ var BIOMARKER_CODE_SYSTEM = "http://fhir-brasil.dev/biomarker-codes";
 var UNIT_TO_UCUM = {
   // Dimensionless / special measurements
   "[pH]": "[pH]",
+  "{index}": "{index}",
   "{ratio}": "{ratio}",
+  "{score}": "{score}",
   "{specific gravity}": "{specific gravity}",
+  "/HPF": "/[HPF]",
+  "/LPF": "/[LPF]",
   "/\xB5L": "/uL",
   // Percentage
   "%": "%",
   // Count units
   "10\xB3/\xB5L": "10*3/uL",
   "10\u2076/\xB5L": "10*6/uL",
+  Angstrom: "Ao",
+  AU: "{score}",
+  cm: "cm",
+  "cm\xB3": "cm3",
+  deg: "deg",
   // Volume
   fL: "fL",
   g: "g",
+  "g/cm\xB2": "g/cm2",
   // Mass concentration
   "g/dL": "g/dL",
+  "g/L": "g/L",
+  "IU/L": "[IU]/L",
+  "IU/mL": "[IU]/mL",
+  "K/uL": "10*3/uL",
+  "kcal/d": "kcal/d",
+  kg: "kg",
+  "kg/m2": "kg/m2",
+  "kg/m\xB2": "kg/m2",
+  "kU/L": "k[IU]/L",
   L: "L",
+  "M/uL": "10*6/uL",
+  "mcg/dL": "ug/dL",
+  "mcg/L": "ug/L",
+  "mcg/mL": "ug/mL",
   // Molar concentration
   "mEq/L": "meq/L",
   mg: "mg",
   "mg/dL": "mg/dL",
+  "mg/g": "mg/g",
+  "mg/L": "mg/L",
+  "mIU/L": "m[IU]/L",
+  "mIU/mL": "m[IU]/mL",
   mL: "mL",
+  "mL/min/1.73m\xB2": "mL/min/{1.73_m2}",
+  mm: "mm",
+  "mm/h": "mm/h",
+  "mm/hr": "mm/h",
   "mmol/L": "mmol/L",
+  "mUI/L": "m[IU]/L",
   "mUI/mL": "m[IU]/mL",
   ng: "ng",
   "ng/dL": "ng/dL",
+  "ng/L": "ng/L",
   "ng/mL": "ng/mL",
   "nmol/L": "nmol/L",
   // Mass
   pg: "pg",
   "pg/mL": "pg/mL",
   pH: "[pH]",
+  "pmol/L": "pmol/L",
+  raz\u00E3o: "{ratio}",
+  score: "{score}",
+  segundos: "s",
   // Enzyme activity
+  U: "U",
   "U/L": "U/L",
   // Special units
   "U/mL": "U/mL",
+  "ug/dL": "ug/dL",
+  "ug/L": "ug/L",
   "UI/L": "[IU]/L",
   "UI/mL": "[IU]/mL",
+  "uIU/mL": "u[IU]/mL",
+  "umol/L": "umol/L",
   \u00B5g: "ug",
   "\xB5g/dL": "ug/dL",
+  "\xB5g/L": "ug/L",
   "\xB5mol/L": "umol/L",
-  "\xB5UI/mL": "u[IU]/mL"
+  "\xB5UI/mL": "u[IU]/mL",
+  \u00EDndice: "{index}"
 };
-var BIOMARKER_DEFAULT_UNIT = {
-  // Proteins
-  Albumin: "g/dL",
-  AlkalinePhosphatase: "U/L",
-  // Liver
-  ALT: "U/L",
-  AST: "U/L",
-  Calcium: "mg/dL",
-  Chloride: "mEq/L",
-  // Lipids
-  Cholesterol: "mg/dL",
-  // Kidney
-  Creatinine: "mg/dL",
-  eAG: "mg/dL",
-  Ferritin: "ng/mL",
-  FolicAcid: "ng/mL",
-  GGT: "U/L",
-  // Glucose/Diabetes
-  Glucose: "mg/dL",
-  HbA1c: "%",
-  Hct: "%",
-  HDL: "mg/dL",
-  // Hematology
-  Hgb: "g/dL",
-  Insulin: "\xB5UI/mL",
-  // Iron studies
-  Iron: "\xB5g/dL",
-  LDL: "mg/dL",
-  Magnesium: "mg/dL",
-  NonHDL_Cholesterol: "mg/dL",
-  // Urinalysis - dimensionless
+var DIMENSIONLESS_DEFAULTS = {
   pH_Urine: "[pH]",
-  Potassium: "mEq/L",
-  RDW: "%",
-  // Electrolytes
-  Sodium: "mEq/L",
-  SpecificGravity_Urine: "{specific gravity}",
-  T3Free: "pg/mL",
-  T4Free: "ng/dL",
-  TIBC: "\xB5g/dL",
-  TotalProtein: "g/dL",
-  TransferrinSaturation: "%",
-  Triglycerides: "mg/dL",
-  // Thyroid
-  TSH: "\xB5UI/mL",
-  Urea: "mg/dL",
-  UricAcid: "mg/dL",
-  // Vitamins
-  VitaminB12: "pg/mL",
-  VitaminD: "ng/mL",
-  VLDL: "mg/dL"
+  SpecificGravity_Urine: "{specific gravity}"
+};
+var BIOMARKER_DEFAULT_UNIT = {
+  ...Object.fromEntries(
+    BIOMARKER_DEFINITIONS.filter((b) => b.unit).map((b) => [b.code, b.unit])
+  ),
+  ...DIMENSIONLESS_DEFAULTS
 };
 function unitToUCUM(unit) {
   return UNIT_TO_UCUM[unit] || unit;
@@ -3423,6 +3516,128 @@ function unitToUCUM(unit) {
 function getDefaultUnit(biomarkerCode) {
   return BIOMARKER_DEFAULT_UNIT[biomarkerCode] || "";
 }
+var UCUM_ATOMS = /* @__PURE__ */ new Set([
+  "m",
+  "g",
+  "s",
+  "L",
+  "l",
+  "mol",
+  "eq",
+  "U",
+  "cal",
+  "h",
+  "d",
+  "min",
+  "wk",
+  "mo",
+  "a",
+  "Ao",
+  "deg",
+  "K",
+  "A",
+  "N",
+  "Pa",
+  "J",
+  "W",
+  "Hz",
+  "V",
+  "C",
+  "osm",
+  "t",
+  "u",
+  "bar",
+  "atm",
+  "rad",
+  "sr",
+  "cd",
+  "Bq",
+  "Gy",
+  "Sv",
+  "lm",
+  "lx",
+  "Cel",
+  "B",
+  "Np"
+]);
+var UCUM_PREFIXES = /* @__PURE__ */ new Set([
+  "Y",
+  "Z",
+  "E",
+  "P",
+  "T",
+  "G",
+  "M",
+  "k",
+  "h",
+  "da",
+  "d",
+  "c",
+  "m",
+  "u",
+  "n",
+  "p",
+  "f",
+  "a",
+  "z",
+  "y"
+]);
+function isUcumAtom(token) {
+  if (token === "%" || /^10\*-?\d+$/.test(token) || /^\d+$/.test(token)) return true;
+  const bracket = /^([A-Za-z]{0,2})\[[^[\]{}\s]+\]$/.exec(token);
+  if (bracket) return bracket[1] === "" || UCUM_PREFIXES.has(bracket[1]);
+  if (UCUM_ATOMS.has(token)) return true;
+  for (const prefix of UCUM_PREFIXES) {
+    if (token.startsWith(prefix) && UCUM_ATOMS.has(token.slice(prefix.length))) return true;
+  }
+  return false;
+}
+function isUcumComponent(token) {
+  const m = /^(.*?)(\{[^{}]*\})?$/.exec(token);
+  if (!m) return false;
+  const [, body, annotation] = m;
+  if (!body) return annotation !== void 0;
+  const exp = /^(.+?)([+-]?\d+)?$/.exec(body);
+  if (!exp) return false;
+  const [, atom, exponent] = exp;
+  if (isUcumAtom(body)) return true;
+  if (exponent === void 0) return false;
+  return isUcumAtom(atom);
+}
+function isUcumCode(code) {
+  if (!code || /[^\x21-\x7E ]/.test(code)) return false;
+  const terms = [];
+  let current = "";
+  let braces = 0;
+  let inBracket = false;
+  for (const ch of code) {
+    if (ch === "{") braces++;
+    else if (ch === "}") {
+      if (braces === 0) return false;
+      braces--;
+    } else if (ch === "[") inBracket = true;
+    else if (ch === "]") inBracket = false;
+    if ((ch === "." || ch === "/") && braces === 0 && !inBracket) {
+      terms.push(current, ch);
+      current = "";
+      continue;
+    }
+    current += ch;
+  }
+  if (braces !== 0 || inBracket) return false;
+  terms.push(current);
+  if (terms[0] === "" && terms[1] === "/") terms[0] = "1";
+  let expectOperand = true;
+  for (const t of terms) {
+    if (expectOperand) {
+      if (!isUcumComponent(t)) return false;
+    } else if (t !== "." && t !== "/") {
+      return false;
+    }
+    expectOperand = !expectOperand;
+  }
+  return !expectOperand;
+}
 var CBC_DIFF_ALIASES = {
   "/ul": "/uL",
   "/\xB5l": "/uL",
@@ -3724,7 +3939,7 @@ var BIOMARKER_UNITS = {
       "miu/ml": "mIU/mL",
       "ui/l": "mIU/mL"
     },
-    canonicalUcum: "mIU/mL",
+    canonicalUcum: "m[iU]/mL",
     canonicalUnit: "mIU/mL",
     siUcum: "[iU]/L",
     siUnit: "IU/L"
@@ -3859,7 +4074,7 @@ var BIOMARKER_UNITS = {
       "miu/ml": "mIU/mL",
       "ui/l": "mIU/mL"
     },
-    canonicalUcum: "mIU/mL",
+    canonicalUcum: "m[iU]/mL",
     canonicalUnit: "mIU/mL",
     siUcum: "[iU]/L",
     siUnit: "IU/L"
@@ -4126,7 +4341,7 @@ var BIOMARKER_UNITS = {
     },
     canonicalUcum: "u[iU]/mL",
     canonicalUnit: "uIU/mL",
-    siUcum: "mIU/L",
+    siUcum: "m[iU]/L",
     siUnit: "mIU/L"
   },
   Urea: {
@@ -4181,635 +4396,105 @@ var BIOMARKER_UNITS = {
 function getCanonicalUnit(code) {
   return BIOMARKER_UNITS[code]?.canonicalUnit ?? null;
 }
-
-// src/converter.ts
-function interpretationCode(flag) {
-  switch (flag) {
-    case "H":
-      return "H";
-    // High
-    case "L":
-      return "L";
-    // Low
-    default:
-      return "N";
-  }
+function normalizeUnit(unit, config) {
+  return config.aliases[unit.toLowerCase()] ?? config.aliases[unit] ?? unit;
 }
-function interpretationDisplay(flag) {
-  switch (flag) {
-    case "H":
-      return "High";
-    case "L":
-      return "Low";
-    default:
-      return "Normal";
+function resolveUcum(unit, biomarkerCode) {
+  if (!unit) return void 0;
+  const config = biomarkerCode ? BIOMARKER_UNITS[biomarkerCode] : void 0;
+  if (config) {
+    const normalized = normalizeUnit(unit, config);
+    if (normalized === config.canonicalUnit) return config.canonicalUcum;
+    if (normalized === config.siUnit) return config.siUcum;
   }
+  const mapped = UNIT_TO_UCUM[unit];
+  if (mapped) return mapped;
+  return isUcumCode(unit) ? unit : void 0;
 }
-var SEX_CODING = {
-  female: {
-    code: "female",
-    display: "Female",
-    system: "http://hl7.org/fhir/administrative-gender"
+
+// src/reference-ranges.ts
+var biomarkerRangeDefinitions = {
+  Albumin_Creatinine_Ratio: {
+    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/g" },
+    kind: "decision-threshold",
+    source: "tietz-7ed-2015"
   },
-  male: { code: "male", display: "Male", system: "http://hl7.org/fhir/administrative-gender" }
-};
-var buildReferenceRanges = (observation, sourceUnit, ucumUnit) => {
-  const quantity = (value) => ({
-    code: ucumUnit,
-    system: "http://unitsofmeasure.org",
-    unit: sourceUnit,
-    value
-  });
-  const toRanges = (low, high, sex) => {
-    if (low === void 0 && high === void 0) return [];
-    return [
+  Adiponectin: {
+    default: { max: 26, min: 4, optimalMax: 20, optimalMin: 8, unit: "mcg/mL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  ADMA: {
+    default: { max: 0.7, min: 0.3, optimalMax: 0.55, optimalMin: 0.3, unit: "umol/L" },
+    kind: "reference-interval",
+    source: "nemeth-adma-2017"
+  },
+  AFP: {
+    default: { max: 10, min: 0, optimalMax: 8, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
+    source: "sturgeon-nacb-2008"
+  },
+  Albumin_Globulin_Ratio: {
+    default: { max: 2.5, min: 1, optimalMax: 2.2, optimalMin: 1.2, unit: "" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  Albumin: {
+    default: { max: 5, min: 3.5, optimalMax: 4.8, optimalMin: 4, unit: "g/dL" },
+    kind: "reference-interval",
+    source: "pns-bioquimica-2019"
+  },
+  AlkalinePhosphatase: {
+    default: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: "U/L" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
+    variants: [
       {
-        ...sex === void 0 ? {} : { appliesTo: [{ coding: [SEX_CODING[sex]] }] },
-        ...high === void 0 ? {} : { high: quantity(high) },
-        ...low === void 0 ? {} : { low: quantity(low) }
-      }
-    ];
-  };
-  if (observation.referenceRanges && observation.referenceRanges.length > 0) {
-    return observation.referenceRanges.flatMap((r) => toRanges(r.low, r.high, r.appliesTo));
-  }
-  return toRanges(observation.referenceMin, observation.referenceMax);
-};
-function labObservationToFHIR(observation, patientId, laboratoryName) {
-  const loincCode = codeToLoinc(observation.biomarkerCode);
-  const sourceUnit = observation.unit || getDefaultUnit(observation.biomarkerCode) || observation.unit;
-  const ucumUnit = unitToUCUM(sourceUnit);
-  const isQualitative = observation.isQualitative || typeof observation.value === "string";
-  const fhirObs = {
-    category: [
+        ageMin: 18,
+        range: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: "U/L" },
+        sex: "M"
+      },
       {
-        coding: [
-          {
-            code: "laboratory",
-            display: "Laboratory",
-            system: "http://terminology.hl7.org/CodeSystem/observation-category"
-          }
-        ]
+        ageMin: 18,
+        range: { max: 104, min: 35, optimalMax: 90, optimalMin: 40, unit: "U/L" },
+        sex: "F"
       }
-    ],
-    code: {
-      // Sem LOINC, o coding LOINC simplesmente não sai. Antes ia `99999-9`,
-      // que não é código LOINC nenhum: publicava sob `http://loinc.org` uma
-      // afirmação falsa, e quem consumisse o bundle confiando no system
-      // trataria aquilo como código de verdade. Composição corporal, densidade
-      // óssea e escore de cálcio não têm LOINC, e o certo é a lacuna explícita.
-      coding: [
-        ...loincCode ? [
-          {
-            code: loincCode,
-            display: observation.biomarkerName,
-            system: LOINC_SYSTEM
-          }
-        ] : [],
-        {
-          code: observation.biomarkerCode,
-          display: observation.biomarkerName,
-          system: BIOMARKER_CODE_SYSTEM
-        }
-      ],
-      text: observation.biomarkerName
-    },
-    effectiveDateTime: observation.collectionDate,
-    id: `${observation.reportId}-${observation.biomarkerCode}`,
-    interpretation: [
+    ]
+  },
+  ALT: {
+    default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/L" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
+    variants: [
       {
-        coding: [
-          {
-            code: interpretationCode(observation.flag),
-            display: interpretationDisplay(observation.flag),
-            system: "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
-          }
-        ]
-      }
-    ],
-    performer: laboratoryName ? [{ display: laboratoryName }] : void 0,
-    resourceType: "Observation",
-    status: "final",
-    subject: {
-      reference: `Patient/${patientId}`
-    }
-  };
-  if (isQualitative) {
-    fhirObs.valueString = String(observation.value);
-  } else {
-    fhirObs.valueQuantity = {
-      code: ucumUnit,
-      system: "http://unitsofmeasure.org",
-      unit: sourceUnit,
-      value: observation.value
-    };
-    const referenceRange = buildReferenceRanges(observation, sourceUnit, ucumUnit);
-    if (referenceRange.length > 0) fhirObs.referenceRange = referenceRange;
-  }
-  return fhirObs;
-}
-function labReportToFHIR(report, patientId, observationIds) {
-  let status;
-  switch (report.processingStatus) {
-    case "complete":
-      status = "final";
-      break;
-    case "partial":
-      status = "partial";
-      break;
-    case "pending_review":
-      status = "preliminary";
-      break;
-    default:
-      status = "final";
-  }
-  return {
-    category: [
+        ageMin: 18,
+        range: { max: 56, min: 7, optimalMax: 35, optimalMin: 10, unit: "U/L" },
+        sex: "M"
+      },
       {
-        coding: [
-          {
-            code: "LAB",
-            display: "Laboratory",
-            system: "http://terminology.hl7.org/CodeSystem/v2-0074"
-          }
-        ]
+        ageMin: 18,
+        range: { max: 45, min: 7, optimalMax: 30, optimalMin: 10, unit: "U/L" },
+        sex: "F"
       }
-    ],
-    code: {
-      coding: [
-        {
-          code: "11502-2",
-          // Laboratory report
-          display: "Laboratory report",
-          system: "http://loinc.org"
-        }
-      ],
-      text: "Laboratory Results"
-    },
-    conclusion: report.overallStatus === "NORMAL" ? "All results within normal limits" : "One or more abnormal results detected",
-    conclusionCode: report.overallStatus === "ANORMAL" ? [
+    ]
+  },
+  // AMH — fortemente dependente de idade e sexo. As variantes femininas por
+  // faixa etária são a referência clínica; o `default` foi ajustado para
+  // refletir uma faixa adulta conservadora (~18-40 anos, mulheres em idade
+  // reprodutiva geral). optimalMax anterior (6.9 ng/mL) sobrepunha-se a
+  // valores sugestivos de SOP ou risco de OHSS; clinicamente, valores acima
+  // de ~4 ng/mL já merecem investigação.
+  AMH: {
+    default: { max: 6, min: 1, optimalMax: 4, optimalMin: 1.5, unit: "ng/mL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
+    variants: [
       {
-        coding: [
-          {
-            code: "A",
-            display: "Abnormal",
-            system: "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
-          }
-        ]
-      }
-    ] : void 0,
-    effectiveDateTime: report.collectionDate,
-    id: report.reportId,
-    issued: report.createdAt,
-    performer: report.laboratoryName ? [{ display: report.laboratoryName }] : void 0,
-    resourceType: "DiagnosticReport",
-    result: observationIds.map((id) => ({ reference: `Observation/${id}` })),
-    status,
-    subject: {
-      reference: `Patient/${patientId}`
-    }
-  };
-}
-function userProfileToFHIR(profile) {
-  const nameParts = profile.name.split(" ");
-  const given = nameParts.slice(0, -1);
-  const family = nameParts[nameParts.length - 1] || "";
-  return {
-    address: profile.address ? [
-      {
-        city: profile.address.city,
-        country: profile.address.country || "BR",
-        line: [
-          profile.address.street && profile.address.number ? `${profile.address.street}, ${profile.address.number}` : profile.address.street,
-          profile.address.complement
-        ].filter(Boolean),
-        postalCode: profile.address.postalCode,
-        state: profile.address.state
-      }
-    ] : void 0,
-    birthDate: profile.birthDate,
-    gender: profile.gender,
-    id: profile.userId,
-    name: [
-      {
-        family,
-        given: given.length > 0 ? given : void 0,
-        text: profile.name
-      }
-    ],
-    resourceType: "Patient",
-    telecom: [
-      ...profile.email ? [{ system: "email", value: profile.email }] : [],
-      ...profile.phone ? [{ system: "phone", value: profile.phone }] : []
-    ].length > 0 ? [
-      ...profile.email ? [{ system: "email", value: profile.email }] : [],
-      ...profile.phone ? [{ system: "phone", value: profile.phone }] : []
-    ] : void 0
-  };
-}
-function labResultToFHIRBundle(report, observations, userProfile) {
-  const patientId = userProfile.userId;
-  const fhirObservations = observations.map((obs) => {
-    const resource = labObservationToFHIR(
-      { ...obs, collectionDate: report.collectionDate },
-      patientId,
-      report.laboratoryName
-    );
-    return { fullUrl: entryFullUrl(resource), resource };
-  });
-  const observationIds = fhirObservations.map((entry) => entry.resource.id);
-  const diagnosticReport = labReportToFHIR(report, patientId, observationIds);
-  const fhirPatient = userProfileToFHIR(userProfile);
-  return {
-    entry: [
-      { fullUrl: entryFullUrl(fhirPatient), resource: fhirPatient },
-      { fullUrl: entryFullUrl(diagnosticReport), resource: diagnosticReport },
-      ...fhirObservations
-    ],
-    resourceType: "Bundle",
-    type: "collection"
-  };
-}
-
-// src/cli/commands/convert.ts
-async function convert(args, json) {
-  const raw = await getInput(args[0]);
-  const data = parseJson(
-    raw,
-    "JSON inv\xE1lido. Forne\xE7a um objeto com { report, observations, profile }."
-  );
-  if (!data.report || !data.observations || !data.profile) {
-    exitWithError(
-      'Formato esperado: { "report": LabReportData, "observations": LabObservationData[], "profile": UserProfileData }'
-    );
-  }
-  const bundle = labResultToFHIRBundle(data.report, data.observations, data.profile);
-  if (json) {
-    outputJson(bundle);
-  } else {
-    outputText(JSON.stringify(bundle, null, 2));
-  }
-}
-
-// src/validators.ts
-function validateFHIRImportBundle(data) {
-  const errors = [];
-  if (!data || typeof data !== "object") {
-    errors.push({ details: "Input must be a JSON object", field: "root" });
-    return errors;
-  }
-  const bundle = data;
-  if (bundle.resourceType !== "Bundle") {
-    errors.push({
-      details: `Expected resourceType "Bundle", got "${String(bundle.resourceType)}"`,
-      field: "resourceType"
-    });
-  }
-  if (!Array.isArray(bundle.entry)) {
-    errors.push({ details: 'Bundle must contain an "entry" array', field: "entry" });
-  } else if (bundle.entry.length === 0) {
-    errors.push({ details: "Bundle entry array is empty", field: "entry" });
-  }
-  return errors;
-}
-
-// src/importer.ts
-var MAX_OBSERVATIONS = 5e3;
-var MAX_FILE_SIZE = 15 * 1024 * 1024;
-function resolveBiomarkerCode(observation) {
-  const coding = observation.code?.coding ?? [];
-  const loincCode = coding.find((c) => c.system === LOINC_SYSTEM)?.code;
-  const declaredCode = coding.find((c) => c.system === BIOMARKER_CODE_SYSTEM)?.code;
-  const seenCodes = [
-    ...loincCode ? [`LOINC ${loincCode}`] : [],
-    ...declaredCode ? [`biomarker code ${declaredCode}`] : []
-  ];
-  let reason;
-  if (seenCodes.length > 0) {
-    reason = `Unknown code: ${seenCodes.join(", ")}`;
-  } else if (coding.length > 0) {
-    const systems = [...new Set(coding.map((c) => c.system ?? "(sem system)"))];
-    reason = `No code in a supported system (found: ${systems.join(", ")})`;
-  } else {
-    reason = "No code found in observation coding";
-  }
-  const fromLoinc = loincCode ? loincToCode(loincCode) : void 0;
-  if (fromLoinc) return { internalCode: fromLoinc, loincCode, reason };
-  if (declaredCode && isValidCode(declaredCode)) {
-    const canonical = normalizeCode(declaredCode);
-    return { internalCode: canonical, loincCode: codeToLoinc(canonical), reason };
-  }
-  return { loincCode, reason };
-}
-function extractFlag(observation) {
-  const code = observation.interpretation?.[0]?.coding?.[0]?.code;
-  if (code === "H" || code === "HH") return "H";
-  if (code === "L" || code === "LL") return "L";
-  return "";
-}
-function extractObservationsFromBundle(bundle) {
-  const observations = [];
-  const skipped = [];
-  for (let i = 0; i < bundle.entry.length; i++) {
-    const entry = bundle.entry[i];
-    if (!entry.resource) {
-      skipped.push({ index: i, reason: "Entry has no resource" });
-      continue;
-    }
-    if (entry.resource.resourceType !== "Observation") {
-      continue;
-    }
-    if (observations.length >= MAX_OBSERVATIONS) {
-      skipped.push({ index: i, reason: `Maximum of ${MAX_OBSERVATIONS} observations exceeded` });
-      continue;
-    }
-    observations.push(entry.resource);
-  }
-  return { observations, skipped };
-}
-function mapFHIRObservationToInternal(observation, index) {
-  const { internalCode, loincCode, reason } = resolveBiomarkerCode(observation);
-  if (!internalCode) {
-    return {
-      skipped: { index, loincCode, reason, resourceType: "Observation" }
-    };
-  }
-  const definition = getDefinitionByCode(internalCode);
-  let value;
-  let unit = "";
-  let isQualitative = false;
-  if (observation.valueQuantity?.value !== void 0) {
-    value = observation.valueQuantity.value;
-    unit = observation.valueQuantity.unit || observation.valueQuantity.code || "";
-  } else if (observation.valueString) {
-    value = observation.valueString;
-    isQualitative = true;
-  } else {
-    return {
-      skipped: {
-        index,
-        loincCode,
-        reason: "Observation has no value (valueQuantity or valueString)",
-        resourceType: "Observation"
-      }
-    };
-  }
-  const collectionDate = observation.effectiveDateTime || observation.effectivePeriod?.start || "";
-  if (!collectionDate) {
-    return {
-      skipped: {
-        index,
-        loincCode,
-        reason: "Observation has no effectiveDateTime or effectivePeriod.start",
-        resourceType: "Observation"
-      }
-    };
-  }
-  let referenceMin;
-  let referenceMax;
-  if (observation.referenceRange?.[0]) {
-    referenceMin = observation.referenceRange[0].low?.value;
-    referenceMax = observation.referenceRange[0].high?.value;
-  }
-  const imported = {
-    biomarkerCode: internalCode,
-    biomarkerName: definition?.names.pt[0] || definition?.names.en[0] || observation.code.text || internalCode,
-    collectionDate,
-    flag: extractFlag(observation),
-    isQualitative,
-    loincCode,
-    referenceMax,
-    referenceMin,
-    unit: unit || definition?.unit || "",
-    value
-  };
-  return { observation: imported };
-}
-function processImportBundle(data) {
-  const validationErrors = validateFHIRImportBundle(data);
-  if (validationErrors.length > 0) {
-    return {
-      errors: validationErrors,
-      imported: [],
-      skipped: [],
-      totalProcessed: 0
-    };
-  }
-  const bundle = data;
-  const { observations, skipped } = extractObservationsFromBundle(bundle);
-  const imported = [];
-  const allSkipped = [...skipped];
-  for (let i = 0; i < observations.length; i++) {
-    const result = mapFHIRObservationToInternal(observations[i], i);
-    if ("observation" in result) {
-      imported.push(result.observation);
-    } else {
-      allSkipped.push(result.skipped);
-    }
-  }
-  return {
-    errors: [],
-    imported,
-    skipped: allSkipped,
-    totalProcessed: observations.length
-  };
-}
-
-// src/cli/commands/import.ts
-async function importBundle(args, json) {
-  const raw = await getInput(args[0]);
-  const bundle = parseJson(raw, "JSON inv\xE1lido.");
-  const result = processImportBundle(bundle);
-  if (json) {
-    outputJson(result);
-    return;
-  }
-  outputText(`Processados: ${result.totalProcessed}`);
-  outputText(`Importados:  ${result.imported.length}`);
-  outputText(`Ignorados:   ${result.skipped.length}`);
-  outputText(`Erros:       ${result.errors.length}`);
-  if (result.imported.length > 0) {
-    outputText("\nObserva\xE7\xF5es importadas:");
-    for (const obs of result.imported) {
-      outputText(`  ${obs.biomarkerCode} (${obs.loincCode}): ${obs.value} ${obs.unit}`);
-    }
-  }
-  if (result.errors.length > 0) {
-    outputText("\nErros:");
-    for (const err of result.errors) {
-      outputText(`  ${err.field}: ${err.details}`);
-    }
-  }
-}
-
-// src/cli/commands/list.ts
-import { parseArgs } from "util";
-async function list(args, json) {
-  const { values } = parseArgs({
-    args,
-    options: {
-      category: { type: "string" },
-      visible: { default: false, type: "boolean" }
-    },
-    strict: false
-  });
-  let defs;
-  if (values.category) {
-    defs = getBiomarkersByCategory(values.category);
-    if (defs.length === 0) {
-      exitWithError(`Categoria n\xE3o encontrada ou vazia: ${values.category}`);
-    }
-  } else if (values.visible) {
-    defs = getVisibleDefinitions();
-  } else {
-    defs = getAllDefinitions();
-  }
-  if (json) {
-    outputJson(defs);
-    return;
-  }
-  const rows = defs.map((d) => [
-    d.code,
-    d.loinc ?? "\u2014",
-    d.names.pt[0] ?? "",
-    d.unit ?? "\u2014",
-    Array.isArray(d.category) ? d.category.join(", ") : d.category
-  ]);
-  outputText(formatTable(["C\xF3digo", "LOINC", "Nome (pt)", "Unidade", "Categoria"], rows));
-  outputText(`
-Total: ${defs.length} biomarcadores`);
-}
-
-// src/cli/commands/loinc-map.ts
-async function loincMap(_args, json) {
-  const defs = getAllDefinitions().filter((d) => d.loinc);
-  if (json) {
-    const map = Object.fromEntries(defs.map((d) => [d.loinc, d.code]));
-    outputJson(map);
-    return;
-  }
-  const rows = defs.map((d) => [d.loinc, d.code, d.names.pt[0] ?? d.names.en[0] ?? ""]);
-  outputText(formatTable(["LOINC", "C\xF3digo", "Nome (pt)"], rows));
-  outputText(`
-Total: ${rows.length} mapeamentos`);
-}
-
-// src/cli/commands/lookup.ts
-function displayDefinition(def) {
-  const cat = Array.isArray(def.category) ? def.category.join(", ") : def.category;
-  outputText(
-    [
-      `Biomarcador: ${def.code}`,
-      `  LOINC:      ${def.loinc ?? "\u2014"}`,
-      `  Nomes (pt): ${def.names.pt.join(", ")}`,
-      `  Nomes (en): ${def.names.en.join(", ")}`,
-      `  Categoria:  ${cat}`,
-      `  Unidade:    ${def.unit ?? "\u2014"}`,
-      `  Sexo:       ${def.sex ?? "ambos"}`,
-      `  Vis\xEDvel:    ${def.hidden ? "n\xE3o" : "sim"}`
-    ].join("\n")
-  );
-}
-async function lookup(args, json) {
-  const code = args[0];
-  if (!code) exitWithError("Uso: fhir-bio lookup <c\xF3digo>");
-  const def = getDefinitionByCode(code);
-  if (!def) exitWithError(`Biomarcador n\xE3o encontrado: ${code}`);
-  if (json) {
-    outputJson(def);
-  } else {
-    displayDefinition(def);
-  }
-}
-async function lookupLoinc(args, json) {
-  const loinc = args[0];
-  if (!loinc) exitWithError("Uso: fhir-bio lookup-loinc <loinc>");
-  const def = getDefinitionByLoinc(loinc);
-  if (!def) exitWithError(`Biomarcador n\xE3o encontrado para LOINC: ${loinc}`);
-  if (json) {
-    outputJson(def);
-  } else {
-    displayDefinition(def);
-  }
-}
-
-// src/cli/commands/range.ts
-import { parseArgs as parseArgs2 } from "util";
-
-// src/reference-ranges.ts
-var biomarkerRangeDefinitions = {
-  Albumin_Creatinine_Ratio: {
-    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/g" },
-    source: "tietz-7ed-2015"
-  },
-  Adiponectin: {
-    default: { max: 26, min: 4, optimalMax: 20, optimalMin: 8, unit: "mcg/mL" },
-    source: "tietz-7ed-2015"
-  },
-  ADMA: {
-    default: { max: 0.7, min: 0.3, optimalMax: 0.55, optimalMin: 0.3, unit: "umol/L" },
-    source: "nemeth-adma-2017"
-  },
-  AFP: {
-    default: { max: 10, min: 0, optimalMax: 8, optimalMin: 0, unit: "ng/mL" },
-    source: "sturgeon-nacb-2008"
-  },
-  Albumin_Globulin_Ratio: {
-    default: { max: 2.5, min: 1, optimalMax: 2.2, optimalMin: 1.2, unit: "" },
-    source: "tietz-7ed-2015"
-  },
-  Albumin: {
-    default: { max: 5, min: 3.5, optimalMax: 4.8, optimalMin: 4, unit: "g/dL" },
-    source: "pns-bioquimica-2019"
-  },
-  AlkalinePhosphatase: {
-    default: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: "U/L" },
-    source: "tietz-7ed-2015",
-    variants: [
-      {
-        ageMin: 18,
-        range: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: "U/L" },
-        sex: "M"
-      },
-      {
-        ageMin: 18,
-        range: { max: 104, min: 35, optimalMax: 90, optimalMin: 40, unit: "U/L" },
-        sex: "F"
-      }
-    ]
-  },
-  ALT: {
-    default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/L" },
-    source: "tietz-7ed-2015",
-    variants: [
-      {
-        ageMin: 18,
-        range: { max: 56, min: 7, optimalMax: 35, optimalMin: 10, unit: "U/L" },
-        sex: "M"
-      },
-      {
-        ageMin: 18,
-        range: { max: 45, min: 7, optimalMax: 30, optimalMin: 10, unit: "U/L" },
-        sex: "F"
-      }
-    ]
-  },
-  // AMH — fortemente dependente de idade e sexo. As variantes femininas por
-  // faixa etária são a referência clínica; o `default` foi ajustado para
-  // refletir uma faixa adulta conservadora (~18-40 anos, mulheres em idade
-  // reprodutiva geral). optimalMax anterior (6.9 ng/mL) sobrepunha-se a
-  // valores sugestivos de SOP ou risco de OHSS; clinicamente, valores acima
-  // de ~4 ng/mL já merecem investigação.
-  AMH: {
-    default: { max: 6, min: 1, optimalMax: 4, optimalMin: 1.5, unit: "ng/mL" },
-    source: "tietz-7ed-2015",
-    variants: [
-      {
-        ageMax: 24,
-        ageMin: 18,
-        range: { max: 13, min: 1.5, optimalMax: 10, optimalMin: 3, unit: "ng/mL" },
-        sex: "F"
-      },
+        ageMax: 24,
+        ageMin: 18,
+        range: { max: 13, min: 1.5, optimalMax: 10, optimalMin: 3, unit: "ng/mL" },
+        sex: "F"
+      },
       {
         ageMax: 30,
         ageMin: 25,
@@ -4837,14 +4522,17 @@ var biomarkerRangeDefinitions = {
   },
   Ammonia: {
     default: { max: 45, min: 15, optimalMax: 40, optimalMin: 20, unit: "umol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   AntiThyroglobulin: {
     default: { max: 115, min: 0, optimalMax: 40, optimalMin: 0, unit: "IU/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   AntiTPO: {
     default: { max: 34, min: 0, optimalMax: 9, optimalMin: 0, unit: "IU/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Aortic valve calcium — no standardized clinical threshold; use mild cutoff
@@ -4852,23 +4540,28 @@ var biomarkerRangeDefinitions = {
   AorticValveCalcium: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   ApoA1: {
     default: { max: 200, min: 100, optimalMax: 180, optimalMin: 120, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "contois-apoa1-1996"
   },
   ApoB: {
     default: { max: 90, min: 0, optimalMax: 70, optimalMin: 0, unit: "mg/dL" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   ApoCIII: {
     default: { max: 10, min: 0, optimalMax: 7, optimalMin: 0, unit: "mg/dL" },
+    kind: "decision-threshold",
     source: "khetarpal-apociii-2016"
   },
   Omega6_AA: {
     default: { max: 15, min: 5, optimalMax: 12, optimalMin: 7, unit: "%" },
+    kind: "decision-threshold",
     source: "simopoulos-omega-ratio-2002"
   },
   // Razão Ácido Araquidônico/EPA (sangue total) — `lower-better`: razão menor =
@@ -4881,16 +4574,19 @@ var biomarkerRangeDefinitions = {
   // dentro do intervalo. Sem `optimal*`: não há corte ótimo de AA/EPA com fonte.
   // Em telas de relatório único, prefira o intervalo impresso pelo laboratório.
   AA_EPA_Ratio: {
-    default: { max: 40.7, min: 3.7, unit: "" },
+    default: { max: 40.7, min: 3.7, minKind: "display", unit: "" },
     direction: "lower-better",
+    kind: "population",
     source: "torrissen-omega3-dbs-2025"
   },
   Arsenic: {
     default: { max: 35, min: 0, optimalMax: 20, optimalMin: 0, unit: "mcg/L" },
+    kind: "decision-threshold",
     source: "nr7-pcmso-2020"
   },
   AST: {
     default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -4909,6 +4605,7 @@ var biomarkerRangeDefinitions = {
   // Tabela 2 da PNS 2019. Ver o comentário em `Neutrophils_Abs`.
   Basophils_Abs: {
     default: { max: 0.072, min: 0, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 0.062, min: 0, unit: "K/uL" }, sex: "M" },
@@ -4917,6 +4614,7 @@ var biomarkerRangeDefinitions = {
   },
   Bicarbonate: {
     default: { max: 29, min: 23, optimalMax: 28, optimalMin: 24, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // β-Hidroxibutirato (BHB) sérico — corpos cetônicos. Faixa derivada de
@@ -4926,23 +4624,28 @@ var biomarkerRangeDefinitions = {
   // superior aqui reflete estado pós-prandial habitual, não jejum.
   BetaHydroxybutyrate: {
     default: { max: 0.28, min: 0.02, optimalMax: 0.28, optimalMin: 0.02, unit: "mmol/L" },
+    kind: "reference-interval",
     source: "klee-bhb-2020"
   },
   BilirubinDirect: {
     default: { max: 0.3, min: 0, optimalMax: 0.2, optimalMin: 0, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   BilirubinIndirect: {
     default: { max: 0.8, min: 0, optimalMax: 0.6, optimalMin: 0, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   BilirubinTotal: {
     default: { max: 1.2, min: 0.1, optimalMax: 0.9, optimalMin: 0.2, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // BNP: 35 pg/mL = corte não-agudo para triagem de IC (SBC IC 2018)
   BNP: {
     default: { max: 35, min: 0, optimalMax: 20, optimalMin: 0, unit: "pg/mL" },
+    kind: "decision-threshold",
     source: "sbc-ic-2018"
   },
   // Razão BUN/Creatinina — faixa 10-20 aplica-se ao Nitrogênio Ureico (BUN).
@@ -4953,14 +4656,17 @@ var biomarkerRangeDefinitions = {
   // distinta. Ver issue #41 para alinhamento de nomenclatura/LOINC.
   BUN_Creatinine_Ratio: {
     default: { max: 20, min: 10, optimalMax: 18, optimalMin: 12, unit: "" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CA125: {
     default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008"
   },
   CA199: {
     default: { max: 37, min: 0, optimalMax: 30, optimalMin: 0, unit: "U/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008"
   },
   // CAC: Agatston classification — 0=none, 1-99=mild, 100-399=moderate, 400+=severe
@@ -4968,44 +4674,53 @@ var biomarkerRangeDefinitions = {
   CAC: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   // Per-vessel scores — same Agatston classification applied per vessel
   CAC_LAD: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   CAC_LCX: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   CAC_LMA: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   CAC_Percentile: {
     default: { max: 50, min: 0, optimalMax: 25, optimalMin: 0, unit: "%", warningMax: 75 },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   CAC_RCA: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   Cadmium: {
     default: { max: 1.2, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "mcg/L" },
+    kind: "decision-threshold",
     source: "nr7-pcmso-2020"
   },
   Calcium: {
     default: { max: 10.5, min: 8.5, optimalMax: 10, optimalMin: 9, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CEA: {
     default: { max: 3, min: 0, optimalMax: 2.5, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008"
   },
   // CK: valores conservadores baseados em faixas laboratoriais típicas
@@ -5030,6 +4745,7 @@ var biomarkerRangeDefinitions = {
   // autodeclaração de raça/Cor". Ver a issue #3 para a decisão registrada.
   CK: {
     default: { max: 314, min: 30, optimalMax: 170, optimalMin: 40, unit: "U/L" },
+    kind: "reference-interval",
     source: "kalaria-ck-ri-2026",
     variants: [
       { sex: "F", range: { max: 170, min: 30, optimalMax: 150, optimalMin: 40, unit: "U/L" } }
@@ -5037,6 +4753,7 @@ var biomarkerRangeDefinitions = {
   },
   Chloride: {
     default: { max: 106, min: 98, optimalMax: 105, optimalMin: 100, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Colesterol total — SBC 2017/2025: valor desejável < 190 mg/dL para adultos,
@@ -5044,6 +4761,7 @@ var biomarkerRangeDefinitions = {
   // (NCEP, 2002), superada pelas atualizações brasileiras.
   Cholesterol: {
     default: { max: 190, min: 0, optimalMax: 170, optimalMin: 0, unit: "mg/dL" },
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   // Índice de Castelli I (CT/HDL-c)
@@ -5051,6 +4769,7 @@ var biomarkerRangeDefinitions = {
     // Índice de Castelli I — SBC 2017: M <4.9, F <4.3
     default: { max: 4.9, min: 0, optimalMax: 3.5, optimalMin: 0, unit: "" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "castelli-ratio-1992",
     variants: [
       {
@@ -5067,22 +4786,27 @@ var biomarkerRangeDefinitions = {
   },
   CO2: {
     default: { max: 29, min: 23, optimalMax: 28, optimalMin: 24, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Copper: {
     default: { max: 175, min: 70, optimalMax: 150, optimalMin: 85, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CoQ10: {
     default: { max: 1.5, min: 0.5, optimalMax: 1.3, optimalMin: 0.7, unit: "mg/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Cortisol: {
     default: { max: 25, min: 5, optimalMax: 20, optimalMin: 10, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CortisolFree: {
     default: { max: 2.5, min: 0.5, optimalMax: 2, optimalMin: 0.8, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CPeptide: {
@@ -5094,10 +4818,12 @@ var biomarkerRangeDefinitions = {
       optimalMin: 1,
       unit: "ng/mL"
     },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Creatinine: {
     default: { max: 1.2, min: 0.6, optimalMax: 1, optimalMin: 0.7, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "pns-bioquimica-2019",
     variants: [
       // Gestação: hiperfiltração glomerular (↑ 40–50% GFR) reduz a creatinina
@@ -5123,10 +4849,12 @@ var biomarkerRangeDefinitions = {
   CRP: {
     default: { max: 3, min: 0, optimalMax: 1, optimalMin: 0, unit: "mg/L" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "tietz-7ed-2015"
   },
   CystatinC: {
     default: { max: 1, min: 0.5, optimalMax: 0.9, optimalMin: 0.6, unit: "mg/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // D-Dímero — exame de exclusão de TEV (tromboembolismo venoso) com
@@ -5140,6 +4868,7 @@ var biomarkerRangeDefinitions = {
   DDimer: {
     default: { max: 500, min: 0, unit: "ng/mL" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "wells-ddimer-2003",
     variants: [
       // Corte ajustado por idade — ESC 2019 (Konstantinides et al.) e
@@ -5153,10 +4882,12 @@ var biomarkerRangeDefinitions = {
   },
   Omega3_DHA: {
     default: { max: 8, min: 2, optimalMax: 6.5, optimalMin: 3.5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   DHEAS: {
     default: { max: 500, min: 100, optimalMax: 400, optimalMin: 150, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5197,20 +4928,30 @@ var biomarkerRangeDefinitions = {
   },
   Omega3_DPA: {
     default: { max: 2, min: 0.3, optimalMax: 1.5, optimalMin: 0.5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   eGFR: {
-    default: { max: 120, min: 60, optimalMax: 120, optimalMin: 90, unit: "mL/min/1.73m\xB2" },
+    default: {
+      max: 120,
+      maxKind: "display",
+      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.
+    kind: "decision-threshold",
     source: "kdigo-ckd-2024"
   },
   // `Eosinophils` (%) fica sem faixa de propósito e `Eosinophils_Abs` usa os limites da
   // Tabela 2 da PNS 2019. Ver o comentário em `Neutrophils_Abs`.
   Eosinophils_Abs: {
     default: { max: 0.66, min: 0, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 0.66, min: 0, unit: "K/uL" }, sex: "M" },
@@ -5219,18 +4960,22 @@ var biomarkerRangeDefinitions = {
   },
   Omega3_EPA: {
     default: { max: 3.5, min: 0.5, optimalMax: 2.5, optimalMin: 1, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   EPADPADHA: {
     default: { max: 10, min: 3, optimalMax: 9, optimalMin: 5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   ESR: {
     default: { max: 20, min: 0, optimalMax: 10, optimalMin: 0, unit: "mm/hr" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Estradiol: {
     default: { max: 40, min: 10, optimalMax: 35, optimalMin: 15, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5253,6 +4998,7 @@ var biomarkerRangeDefinitions = {
   },
   F2Isoprostanes: {
     default: { max: 86, min: 0, optimalMax: 60, optimalMin: 0, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Ferritina — WHO 2020 é o documento de referência específico para avaliação
@@ -5262,6 +5008,7 @@ var biomarkerRangeDefinitions = {
   // tipo de faixa, mas documentado aqui para consumidores).
   Ferritin: {
     default: { max: 150, min: 12, optimalMax: 120, optimalMin: 30, unit: "ng/mL" },
+    kind: "decision-threshold",
     source: "who-iron-2020",
     variants: [
       // Gestação: ferritina cai fisiologicamente no 2º/3º trimestre pela expansão
@@ -5294,14 +5041,17 @@ var biomarkerRangeDefinitions = {
   // Fibrinogênio: 200-400 mg/dL — faixa de referência padrão (método de Clauss)
   Fibrinogen: {
     default: { max: 400, min: 200, optimalMax: 350, optimalMin: 250, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   FolicAcid: {
     default: { max: 20, min: 3, optimalMax: 15, optimalMin: 5, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   FSH: {
     default: { max: 12.4, min: 1.5, optimalMax: 10, optimalMin: 3, unit: "mIU/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5325,26 +5075,29 @@ var biomarkerRangeDefinitions = {
   GGT: {
     default: { max: 55, min: 0, optimalMax: 30, optimalMin: 0, unit: "U/L" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
         ageMin: 18,
-        range: { max: 61, min: 8, optimalMax: 40, optimalMin: 10, unit: "U/L" },
+        range: { max: 61, min: 8, minKind: "display", optimalMax: 40, optimalMin: 10, unit: "U/L" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 36, min: 5, optimalMax: 25, optimalMin: 8, unit: "U/L" },
+        range: { max: 36, min: 5, minKind: "display", optimalMax: 25, optimalMin: 8, unit: "U/L" },
         sex: "F"
       }
     ]
   },
   Ghrelin: {
     default: { max: 1e3, min: 300, optimalMax: 800, optimalMin: 400, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Globulin: {
     default: { max: 3.5, min: 2, optimalMax: 3.2, optimalMin: 2.3, unit: "g/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // A faixa é de jejum, então mora na definição que afirma jejum. Glicose
@@ -5367,6 +5120,7 @@ var biomarkerRangeDefinitions = {
       optimalMin: 70,
       unit: "mg/dL"
     },
+    kind: "decision-threshold",
     source: "sbd-diabetes-2024",
     variants: [
       // Gestação: DMG (IADPSG/SBD 2024) usa cortes mais restritivos na glicemia
@@ -5388,10 +5142,12 @@ var biomarkerRangeDefinitions = {
   },
   GlycoMark: {
     default: { max: 40, min: 10, optimalMax: 35, optimalMin: 15, unit: "mcg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   GrowthHormone: {
     default: { max: 5, min: 0, optimalMax: 3, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // HbA1c — SBD 2024 não estabelece piso de referência clinicamente acionável.
@@ -5401,11 +5157,13 @@ var biomarkerRangeDefinitions = {
   // criar flag clínico em valores fisiologicamente baixos. optimalMin preserva
   // o alvo fisiológico da fração glicada.
   HbA1c: {
-    default: { max: 5.7, min: 2, optimalMax: 5.3, optimalMin: 4.5, unit: "%" },
+    default: { max: 5.7, min: 2, minKind: "display", optimalMax: 5.3, optimalMin: 4.5, unit: "%" },
+    kind: "decision-threshold",
     source: "sbd-diabetes-2024"
   },
   Hct: {
     default: { max: 50, min: 36, optimalMax: 48, optimalMin: 40, unit: "%" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       {
@@ -5427,18 +5185,40 @@ var biomarkerRangeDefinitions = {
   // não como ponto de corte clínico; consumidores devem tratar `direction:
   // higher-better` como sinal autoritativo.
   HDL: {
-    default: { max: 100, min: 40, optimalMax: 100, optimalMin: 50, unit: "mg/dL" },
+    default: {
+      max: 100,
+      maxKind: "display",
+      min: 40,
+      optimalMax: 100,
+      optimalMin: 50,
+      unit: "mg/dL"
+    },
     direction: "higher-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025",
     variants: [
       {
         ageMin: 18,
-        range: { max: 100, min: 40, optimalMax: 100, optimalMin: 45, unit: "mg/dL" },
+        range: {
+          max: 100,
+          maxKind: "display",
+          min: 40,
+          optimalMax: 100,
+          optimalMin: 45,
+          unit: "mg/dL"
+        },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 100, min: 50, optimalMax: 100, optimalMin: 55, unit: "mg/dL" },
+        range: {
+          max: 100,
+          maxKind: "display",
+          min: 50,
+          optimalMax: 100,
+          optimalMin: 55,
+          unit: "mg/dL"
+        },
         sex: "F"
       }
     ]
@@ -5446,12 +5226,21 @@ var biomarkerRangeDefinitions = {
   HDL_Large: {
     // HDL Large: higher is better
     // Quest Ion Mobility reference: Male 4334-10815, Female 5038-17886 nmol/L, optimal >6729
-    default: { max: 17886, min: 4334, optimalMax: 17886, optimalMin: 6729, unit: "nmol/L" },
+    default: {
+      max: 17886,
+      maxKind: "display",
+      min: 4334,
+      optimalMax: 17886,
+      optimalMin: 6729,
+      unit: "nmol/L"
+    },
     direction: "higher-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   Hgb: {
     default: { max: 17.5, min: 12, optimalMax: 16, optimalMin: 13.5, unit: "g/dL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       // Gestação: hemodiluição fisiológica reduz o piso aceitável.
@@ -5507,19 +5296,23 @@ var biomarkerRangeDefinitions = {
       warningMax: 2.71
     },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "geloneze-brams-2009"
   },
   Homocysteine: {
-    default: { max: 15, min: 4, optimalMax: 10, optimalMin: 5, unit: "umol/L" },
+    default: { max: 15, min: 4, minKind: "display", optimalMax: 10, optimalMin: 5, unit: "umol/L" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "selhub-homocysteine-1999"
   },
   IGF1: {
     default: { max: 350, min: 100, optimalMax: 300, optimalMin: 150, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   ImmatureGranulocytes: {
     default: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Insulin: {
@@ -5531,10 +5324,12 @@ var biomarkerRangeDefinitions = {
       optimalMin: 3,
       unit: "uIU/mL"
     },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Iron: {
     default: { max: 170, min: 60, optimalMax: 140, optimalMin: 80, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "sbpc-ml-2021",
     variants: [
       {
@@ -5551,6 +5346,7 @@ var biomarkerRangeDefinitions = {
   },
   Lactate: {
     default: { max: 2.2, min: 0.5, optimalMax: 1.8, optimalMin: 0.7, unit: "mmol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // DHL/LDH — método IFCC a 37 °C (padrão atual na maioria dos laboratórios
@@ -5562,6 +5358,7 @@ var biomarkerRangeDefinitions = {
   LDH: {
     default: { max: 248, min: 0, optimalMax: 248, optimalMin: 0, unit: "U/L" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "schumann-ifcc-ldh-2002",
     variants: [
       {
@@ -5579,59 +5376,109 @@ var biomarkerRangeDefinitions = {
   LDL: {
     default: { max: 100, min: 0, optimalMax: 70, optimalMin: 0, unit: "mg/dL" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   LDL_Medium: {
     // LDL Medium (LDL Média): lower is better
     // Quest Ion Mobility reference: Male 167-485, Female 121-397 nmol/L, optimal <215
-    default: { max: 485, min: 121, optimalMax: 215, optimalMin: 121, unit: "nmol/L" },
+    default: {
+      max: 485,
+      min: 121,
+      minKind: "display",
+      optimalMax: 215,
+      optimalMin: 121,
+      unit: "nmol/L"
+    },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   LDL_ParticleNumber: {
     // LDL Particle Number: lower is better
     // Quest Ion Mobility reference: 1016-2185 nmol/L, optimal <1138
-    default: { max: 2185, min: 1016, optimalMax: 1138, optimalMin: 1016, unit: "nmol/L" },
+    default: {
+      max: 2185,
+      min: 1016,
+      minKind: "display",
+      optimalMax: 1138,
+      optimalMin: 1016,
+      unit: "nmol/L"
+    },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   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: "Angstrom" },
+    default: {
+      max: 250,
+      maxKind: "display",
+      min: 217.4,
+      optimalMax: 250,
+      optimalMin: 222.9,
+      unit: "Angstrom"
+    },
     direction: "higher-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   LDL_Small: {
     // LDL Small (LDL Pequena): lower is better (small dense LDL is most atherogenic)
     // Quest Ion Mobility reference: Male 123-441, Female 126-382 nmol/L, optimal <142
-    default: { max: 441, min: 123, optimalMax: 142, optimalMin: 123, unit: "nmol/L" },
+    default: {
+      max: 441,
+      min: 123,
+      minKind: "display",
+      optimalMax: 142,
+      optimalMin: 123,
+      unit: "nmol/L"
+    },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   Lead: {
     default: { max: 5, min: 0, optimalMax: 2, optimalMin: 0, unit: "mcg/dL" },
+    kind: "decision-threshold",
     source: "nr7-pcmso-2020"
   },
   Leptin: {
-    default: { max: 15, min: 2, optimalMax: 12, optimalMin: 3, unit: "ng/mL" },
+    default: { max: 15, min: 2, minKind: "clinical", optimalMax: 12, optimalMin: 3, unit: "ng/mL" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
         ageMin: 18,
-        range: { max: 10, min: 1, optimalMax: 8, optimalMin: 2, unit: "ng/mL" },
+        range: {
+          max: 10,
+          min: 1,
+          minKind: "clinical",
+          optimalMax: 8,
+          optimalMin: 2,
+          unit: "ng/mL"
+        },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 25, min: 4, optimalMax: 18, optimalMin: 5, unit: "ng/mL" },
+        range: {
+          max: 25,
+          min: 4,
+          minKind: "clinical",
+          optimalMax: 18,
+          optimalMin: 5,
+          unit: "ng/mL"
+        },
         sex: "F"
       }
     ]
   },
   LH: {
     default: { max: 8.6, min: 1.7, optimalMax: 8, optimalMin: 2, unit: "mIU/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5654,6 +5501,7 @@ var biomarkerRangeDefinitions = {
   },
   Omega6_LA: {
     default: { max: 35, min: 15, optimalMax: 28, optimalMin: 18, unit: "%" },
+    kind: "decision-threshold",
     source: "simopoulos-omega-ratio-2002"
   },
   // Lp(a) — SBC 2025 (seção 3.1.1.2.7): níveis ≥ 50 mg/dL ou ≥ 125 nmol/L são
@@ -5665,12 +5513,14 @@ var biomarkerRangeDefinitions = {
   Lipoprotein_a: {
     default: { max: 125, min: 0, optimalMax: 75, optimalMin: 0, unit: "nmol/L" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   // `Lymphocytes` (%) fica sem faixa de propósito e `Lymphocytes_Abs` usa os limites da
   // Tabela 2 da PNS 2019. Ver o comentário em `Neutrophils_Abs`.
   Lymphocytes_Abs: {
     default: { max: 3.414, min: 0.72, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 3.37, min: 0.72, unit: "K/uL" }, sex: "M" },
@@ -5679,40 +5529,49 @@ var biomarkerRangeDefinitions = {
   },
   Magnesium: {
     default: { max: 2.2, min: 1.7, optimalMax: 2.1, optimalMin: 1.9, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Magnesium_RBC: {
     default: { max: 6.8, min: 4, optimalMax: 6, optimalMin: 4.5, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   MCH: {
     default: { max: 33, min: 27, optimalMax: 32, optimalMin: 28, unit: "pg" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   MCHC: {
     default: { max: 36, min: 32, optimalMax: 35, optimalMin: 33, unit: "g/dL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   MCV: {
     default: { max: 100, min: 80, optimalMax: 98, optimalMin: 82, unit: "fL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   Mercury: {
     default: { max: 10, min: 0, optimalMax: 5, optimalMin: 0, unit: "mcg/L" },
+    kind: "decision-threshold",
     source: "nr7-pcmso-2020"
   },
   Microalbumin: {
     default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/L" },
+    kind: "decision-threshold",
     source: "kdigo-ckd-2024"
   },
   MMA: {
     default: { max: 378, min: 0, optimalMax: 270, optimalMin: 0, unit: "nmol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // `Monocytes` (%) fica sem faixa de propósito e `Monocytes_Abs` usa os limites da
   // Tabela 2 da PNS 2019. Ver o comentário em `Neutrophils_Abs`.
   Monocytes_Abs: {
     default: { max: 0.812, min: 0.011, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 0.812, min: 0.011, unit: "K/uL" }, sex: "M" },
@@ -5721,11 +5580,13 @@ var biomarkerRangeDefinitions = {
   },
   MPV: {
     default: { max: 11.5, min: 7.5, optimalMax: 10.5, optimalMin: 8, unit: "fL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   // MPO: Meuwese 2007 (EPIC-Norfolk) — risco CV elevado >322 pmol/L
   Myeloperoxidase: {
     default: { max: 470, min: 0, optimalMax: 322, optimalMin: 0, unit: "pmol/L" },
+    kind: "decision-threshold",
     source: "meuwese-mpo-2007"
   },
   // Leucograma diferencial em percentual (`Neutrophils`, `Lymphocytes`,
@@ -5749,6 +5610,7 @@ var biomarkerRangeDefinitions = {
   // (menor mínimo e maior máximo entre homens e mulheres).
   Neutrophils_Abs: {
     default: { max: 6.474, min: 0.576, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 5.971, min: 0.576, unit: "K/uL" }, sex: "M" },
@@ -5758,22 +5620,27 @@ var biomarkerRangeDefinitions = {
   NonHDL_Cholesterol: {
     default: { max: 130, min: 0, optimalMax: 100, optimalMin: 0, unit: "mg/dL" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   NRBC: {
     default: { max: 0, min: 0, optimalMax: 0, optimalMin: 0, unit: "/100WBC" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   NTproBNP: {
     default: { max: 125, min: 0, optimalMax: 75, optimalMin: 0, unit: "pg/mL" },
+    kind: "decision-threshold",
     source: "sbc-ic-2018"
   },
   Oleic_Acid: {
     default: { max: 25, min: 15, optimalMax: 22, optimalMin: 18, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Omega3_Index: {
     default: { max: 8, min: 4, optimalMax: 8, optimalMin: 5.5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   // Ômega-3 Total (% de ácidos graxos eritrocitários) — Harris & von Schacky
@@ -5783,39 +5650,55 @@ var biomarkerRangeDefinitions = {
   // a literatura e o próprio texto educacional do `platform`.
   Omega3_Total: {
     default: { max: 12, min: 3, optimalMax: 10, optimalMin: 8, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   Omega6_Total: {
     default: { max: 40, min: 20, optimalMax: 35, optimalMin: 25, unit: "%" },
+    kind: "decision-threshold",
     source: "simopoulos-omega-ratio-2002"
   },
   Omega6_Omega3_Ratio: {
-    default: { max: 10, min: 1, optimalMax: 4, optimalMin: 1, unit: "" },
+    default: {
+      max: 10,
+      min: 1,
+      minKind: "display",
+      optimalMax: 4,
+      optimalMin: 1,
+      unit: ""
+    },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "simopoulos-omega-ratio-2002"
   },
   OmegaCheck: {
     default: { max: 8, min: 4, optimalMax: 8, optimalMin: 5.5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   Palmitic_Acid: {
     default: { max: 30, min: 20, optimalMax: 27, optimalMin: 22, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Phosphorus: {
     default: { max: 4.5, min: 2.5, optimalMax: 4, optimalMin: 3, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Platelets: {
     default: { max: 400, min: 150, optimalMax: 350, optimalMin: 180, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   Potassium: {
     default: { max: 5, min: 3.5, optimalMax: 4.6, optimalMin: 3.8, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Prealbumin: {
     default: { max: 38, min: 18, optimalMax: 35, optimalMin: 20, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Progesterona — varia drasticamente com a fase do ciclo menstrual.
@@ -5826,6 +5709,7 @@ var biomarkerRangeDefinitions = {
   // ciclo, indisponível neste contexto.
   Progesterone: {
     default: { max: 0.9, min: 0.1, optimalMax: 0.7, optimalMin: 0.2, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5852,6 +5736,7 @@ var biomarkerRangeDefinitions = {
   },
   Prolactin: {
     default: { max: 18, min: 2, optimalMax: 15, optimalMin: 4, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5868,6 +5753,7 @@ var biomarkerRangeDefinitions = {
   },
   PSA: {
     default: { max: 4, min: 0, optimalMax: 2.5, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008",
     variants: [
       {
@@ -5897,6 +5783,7 @@ var biomarkerRangeDefinitions = {
   },
   RBC: {
     default: { max: 5.5, min: 4, optimalMax: 5.2, optimalMin: 4.3, unit: "M/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       {
@@ -5913,22 +5800,27 @@ var biomarkerRangeDefinitions = {
   },
   RDW: {
     default: { max: 14.5, min: 11.5, optimalMax: 14, optimalMin: 12, unit: "%" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   Reticulocytes: {
     default: { max: 2.5, min: 0.5, optimalMax: 2, optimalMin: 0.8, unit: "%" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   SDMA: {
     default: { max: 0.6, min: 0.3, optimalMax: 0.5, optimalMin: 0.3, unit: "umol/L" },
+    kind: "reference-interval",
     source: "schwedhelm-sdma-2011"
   },
   Selenium: {
     default: { max: 150, min: 70, optimalMax: 125, optimalMin: 85, unit: "\xB5g/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   SHBG: {
     default: { max: 54, min: 18, optimalMax: 50, optimalMin: 20, unit: "nmol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5945,34 +5837,42 @@ var biomarkerRangeDefinitions = {
   },
   Sodium: {
     default: { max: 145, min: 136, optimalMax: 143, optimalMin: 138, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   SpecificGravity_Urine: {
     default: { max: 1.03, min: 1.005, optimalMax: 1.025, optimalMin: 1.01, unit: "SG" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Stearic_Acid: {
     default: { max: 14, min: 8, optimalMax: 12, optimalMin: 10, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   T3Free: {
     default: { max: 4.2, min: 2.3, optimalMax: 3.8, optimalMin: 2.8, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   T3Reverse: {
     default: { max: 24, min: 10, optimalMax: 20, optimalMin: 12, unit: "ng/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   T4Free: {
     default: { max: 1.8, min: 0.8, optimalMax: 1.5, optimalMin: 1, unit: "ng/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   T4Total: {
     default: { max: 12, min: 4.5, optimalMax: 10, optimalMin: 6, unit: "ug/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Testosterone: {
     default: { max: 1e3, min: 300, optimalMax: 800, optimalMin: 500, unit: "ng/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5995,12 +5895,14 @@ var biomarkerRangeDefinitions = {
   },
   TestosteroneBioavailable: {
     default: { max: 200, min: 50, optimalMax: 150, optimalMin: 80, unit: "ng/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // TestosteroneFree - using direct immunoassay ranges (Quest/LabCorp standard)
   // Previous values (9.3-26.5 pg/mL) were based on equilibrium dialysis method
   TestosteroneFree: {
     default: { max: 155, min: 35, optimalMax: 120, optimalMin: 50, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6023,22 +5925,27 @@ var biomarkerRangeDefinitions = {
   },
   TIBC: {
     default: { max: 370, min: 250, optimalMax: 350, optimalMin: 280, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   TotalProtein: {
     default: { max: 8.3, min: 6, optimalMax: 7.8, optimalMin: 6.5, unit: "g/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Trans_Fat_Index: {
     default: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Transferrin: {
     default: { max: 360, min: 200, optimalMax: 340, optimalMin: 220, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   TransferrinSaturation: {
     default: { max: 50, min: 20, optimalMax: 45, optimalMin: 25, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6066,16 +5973,19 @@ var biomarkerRangeDefinitions = {
       unit: "mg/dL"
     },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   // TroponinI: 0.04 ng/mL = percentil 99 (ensaio Siemens TnI-Ultra)
   TroponinI: {
     default: { max: 0.04, min: 0, optimalMax: 0.02, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "keller-tni-2013"
   },
   // TroponinT: 14 ng/L = percentil 99 hs-cTnT (ensaio Roche Elecsys 5ª geração)
   TroponinT: {
     default: { max: 14, min: 0, optimalMax: 10, optimalMin: 0, unit: "ng/L" },
+    kind: "reference-interval",
     source: "giannitsis-hstnt-2010"
   },
   // TSH — 0.4–4.0 é a faixa de referência adulta geral. O alvo 2.5 µIU/mL é
@@ -6085,6 +5995,7 @@ var biomarkerRangeDefinitions = {
   // expandido (tolerância fisiológica do eixo em idosos, SBEM 2013).
   TSH: {
     default: { max: 4, min: 0.4, optimalMax: 3, optimalMin: 1, unit: "uIU/mL" },
+    kind: "reference-interval",
     source: "sbem-thyroid-2013",
     variants: [
       // Variantes gestacionais (ATA 2017 / SBEM): supressão fisiológica por hCG
@@ -6133,10 +6044,12 @@ var biomarkerRangeDefinitions = {
   // deve ser revisto em biomarkers.ts — ver issue #41.
   Urea: {
     default: { max: 50, min: 15, optimalMax: 40, optimalMin: 20, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   UricAcid: {
     default: { max: 7, min: 2.5, optimalMax: 5.5, optimalMin: 3, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6153,50 +6066,62 @@ var biomarkerRangeDefinitions = {
   },
   Urobilinogen_Urine: {
     default: { max: 1, min: 0.1, optimalMax: 1, optimalMin: 0.1, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   pH_Urine: {
     default: { max: 8, min: 4.5, optimalMax: 7, optimalMin: 5.5, unit: "pH" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   HyalineCasts_Urine: {
     default: { max: 2, min: 0, optimalMax: 1, optimalMin: 0, unit: "/LPF" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   RBC_Urine: {
     default: { max: 3, min: 0, optimalMax: 1, optimalMin: 0, unit: "/HPF" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   SquamousEpithelial_Urine: {
     default: { max: 15, min: 0, optimalMax: 5, optimalMin: 0, unit: "/HPF" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Leukocytes_Urine: {
     default: { max: 5, min: 0, optimalMax: 2, optimalMin: 0, unit: "/HPF" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Folate: {
     default: { max: 20, min: 3.9, optimalMax: 17, optimalMin: 5, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminA: {
     default: { max: 100, min: 20, optimalMax: 80, optimalMin: 30, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminB1: {
     default: { max: 180, min: 70, optimalMax: 150, optimalMin: 80, unit: "nmol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminB12: {
     default: { max: 900, min: 200, optimalMax: 800, optimalMin: 400, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminB6: {
     default: { max: 50, min: 5, optimalMax: 40, optimalMin: 10, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminC: {
     default: { max: 2, min: 0.4, optimalMax: 1.5, optimalMin: 0.6, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Vitamina D — posicionamento conjunto SBEM/SBPC-ML 2017:
@@ -6213,6 +6138,7 @@ var biomarkerRangeDefinitions = {
   // quando a modelagem de comorbidades chegar ao schema.
   VitaminD: {
     default: { max: 100, min: 20, optimalMax: 70, optimalMin: 40, unit: "ng/mL" },
+    kind: "decision-threshold",
     source: "ferreira-vitd-2017",
     variants: [
       {
@@ -6224,10 +6150,12 @@ var biomarkerRangeDefinitions = {
   },
   VitaminD_1_25: {
     default: { max: 72, min: 18, optimalMax: 60, optimalMin: 25, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminE: {
     default: { max: 17, min: 5.5, optimalMax: 14, optimalMin: 7, unit: "mg/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // VLDL — estimado clinicamente via TG/5 (método Friedewald). O corte de
@@ -6236,30 +6164,34 @@ var biomarkerRangeDefinitions = {
   // método de cálculo, mas a faixa de referência tem respaldo na diretriz
   // SBC 2025.
   VLDL: {
-    default: { max: 30, min: 2, optimalMax: 20, optimalMin: 5, unit: "mg/dL" },
+    default: { max: 30, min: 2, minKind: "display", optimalMax: 20, optimalMin: 5, unit: "mg/dL" },
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   WBC: {
     default: { max: 11, min: 4, optimalMax: 8, optimalMin: 5, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   Zinc: {
     default: { max: 120, min: 60, optimalMax: 100, optimalMin: 70, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   AndroidFatPct: {
-    default: { max: 35, min: 10, optimalMax: 25, optimalMin: 15, unit: "%" },
+    default: { max: 35, min: 10, minKind: "display", optimalMax: 25, optimalMin: 15, unit: "%" },
     direction: "lower-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 30, min: 10, optimalMax: 22, optimalMin: 12, unit: "%" },
+        range: { max: 30, min: 10, minKind: "display", optimalMax: 22, optimalMin: 12, unit: "%" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 42, min: 15, optimalMax: 32, optimalMin: 20, unit: "%" },
+        range: { max: 42, min: 15, minKind: "display", optimalMax: 32, optimalMin: 20, unit: "%" },
         sex: "F"
       }
     ]
@@ -6310,6 +6242,7 @@ var biomarkerRangeDefinitions = {
   CalfCircumference: {
     default: { unit: "cm" },
     direction: "higher-better",
+    kind: "decision-threshold",
     source: "ewgsop2-2019",
     // O corte não é específico por sexo na fonte; as duas variantes existem
     // porque `RangeVariant` exige o campo, e carregam o mesmo número.
@@ -6321,38 +6254,76 @@ var biomarkerRangeDefinitions = {
   WaistToHeightRatio: {
     default: { max: 0.5, unit: "" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "browning-ashwell-2010"
   },
   AndroidGynoidRatio: {
-    default: { max: 1.2, min: 0.5, optimalMax: 1, optimalMin: 0.6, unit: "" },
+    default: { max: 1.2, min: 0.5, minKind: "display", optimalMax: 1, optimalMin: 0.6, unit: "" },
     direction: "lower-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 1.2, min: 0.6, optimalMax: 1, optimalMin: 0.7, unit: "" },
+        range: {
+          max: 1.2,
+          min: 0.6,
+          minKind: "display",
+          optimalMax: 1,
+          optimalMin: 0.7,
+          unit: ""
+        },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 1, min: 0.4, optimalMax: 0.8, optimalMin: 0.5, unit: "" },
+        range: {
+          max: 1,
+          min: 0.4,
+          minKind: "display",
+          optimalMax: 0.8,
+          optimalMin: 0.5,
+          unit: ""
+        },
         sex: "F"
       }
     ]
   },
   BMC: {
-    default: { max: 3.5, min: 2, optimalMax: 3.2, optimalMin: 2.3, unit: "kg" },
+    default: {
+      max: 3.5,
+      maxKind: "display",
+      min: 2,
+      optimalMax: 3.2,
+      optimalMin: 2.3,
+      unit: "kg"
+    },
     direction: "higher-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 4, min: 2.5, optimalMax: 3.5, optimalMin: 2.8, unit: "kg" },
+        range: {
+          max: 4,
+          maxKind: "display",
+          min: 2.5,
+          optimalMax: 3.5,
+          optimalMin: 2.8,
+          unit: "kg"
+        },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 3, min: 1.8, optimalMax: 2.7, optimalMin: 2, unit: "kg" },
+        range: {
+          max: 3,
+          maxKind: "display",
+          min: 1.8,
+          optimalMax: 2.7,
+          optimalMin: 2,
+          unit: "kg"
+        },
         sex: "F"
       }
     ]
@@ -6360,142 +6331,148 @@ var biomarkerRangeDefinitions = {
   // BodyFatPct — Age-bracketed ranges from Gallagher et al. Am J Clin Nutr 2000;72:694-701
   // (PMID: 10966886) and ACSM Guidelines for Exercise Testing, 11th Ed (2021)
   BodyFatPct: {
-    default: { max: 30, min: 10, optimalMax: 25, optimalMin: 15, unit: "%" },
+    default: { max: 30, min: 10, minKind: "clinical", optimalMax: 25, optimalMin: 15, unit: "%" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "gallagher-bodyfat-2000",
     variants: [
       // Men — age brackets
       {
         ageMax: 25,
         ageMin: 18,
-        range: { max: 25, min: 5, optimalMax: 20, optimalMin: 10, unit: "%" },
+        range: { max: 25, min: 5, minKind: "clinical", optimalMax: 20, optimalMin: 10, unit: "%" },
         sex: "M"
       },
       {
         ageMax: 35,
         ageMin: 26,
-        range: { max: 26, min: 5, optimalMax: 21, optimalMin: 11, unit: "%" },
+        range: { max: 26, min: 5, minKind: "clinical", optimalMax: 21, optimalMin: 11, unit: "%" },
         sex: "M"
       },
       {
         ageMax: 45,
         ageMin: 36,
-        range: { max: 27, min: 5, optimalMax: 22, optimalMin: 12, unit: "%" },
+        range: { max: 27, min: 5, minKind: "clinical", optimalMax: 22, optimalMin: 12, unit: "%" },
         sex: "M"
       },
       {
         ageMax: 55,
         ageMin: 46,
-        range: { max: 28, min: 5, optimalMax: 23, optimalMin: 13, unit: "%" },
+        range: { max: 28, min: 5, minKind: "clinical", optimalMax: 23, optimalMin: 13, unit: "%" },
         sex: "M"
       },
       {
         ageMin: 56,
-        range: { max: 29, min: 5, optimalMax: 24, optimalMin: 14, unit: "%" },
+        range: { max: 29, min: 5, minKind: "clinical", optimalMax: 24, optimalMin: 14, unit: "%" },
         sex: "M"
       },
       // Women — age brackets
       {
         ageMax: 25,
         ageMin: 18,
-        range: { max: 32, min: 13, optimalMax: 28, optimalMin: 18, unit: "%" },
+        range: { max: 32, min: 13, minKind: "clinical", optimalMax: 28, optimalMin: 18, unit: "%" },
         sex: "F"
       },
       {
         ageMax: 35,
         ageMin: 26,
-        range: { max: 33, min: 13, optimalMax: 29, optimalMin: 18, unit: "%" },
+        range: { max: 33, min: 13, minKind: "clinical", optimalMax: 29, optimalMin: 18, unit: "%" },
         sex: "F"
       },
       {
         ageMax: 45,
         ageMin: 36,
-        range: { max: 34, min: 13, optimalMax: 30, optimalMin: 19, unit: "%" },
+        range: { max: 34, min: 13, minKind: "clinical", optimalMax: 30, optimalMin: 19, unit: "%" },
         sex: "F"
       },
       {
         ageMax: 55,
         ageMin: 46,
-        range: { max: 35, min: 13, optimalMax: 31, optimalMin: 20, unit: "%" },
+        range: { max: 35, min: 13, minKind: "clinical", optimalMax: 31, optimalMin: 20, unit: "%" },
         sex: "F"
       },
       {
         ageMin: 56,
-        range: { max: 36, min: 13, optimalMax: 32, optimalMin: 20, unit: "%" },
+        range: { max: 36, min: 13, minKind: "clinical", optimalMax: 32, optimalMin: 20, unit: "%" },
         sex: "F"
       }
     ]
   },
   FatFreeMass: {
-    default: { max: 80, min: 40, optimalMax: 70, optimalMin: 45, unit: "kg" },
+    default: { max: 80, maxKind: "display", min: 40, optimalMax: 70, optimalMin: 45, unit: "kg" },
     direction: "higher-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 90, min: 50, optimalMax: 80, optimalMin: 55, unit: "kg" },
+        range: { max: 90, maxKind: "display", min: 50, optimalMax: 80, optimalMin: 55, unit: "kg" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 60, min: 35, optimalMax: 52, optimalMin: 38, unit: "kg" },
+        range: { max: 60, maxKind: "display", min: 35, optimalMax: 52, optimalMin: 38, unit: "kg" },
         sex: "F"
       }
     ]
   },
   FatMass: {
-    default: { max: 30, min: 5, optimalMax: 20, optimalMin: 8, unit: "kg" },
+    default: { max: 30, min: 5, minKind: "clinical", optimalMax: 20, optimalMin: 8, unit: "kg" },
     direction: "lower-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 25, min: 5, optimalMax: 18, optimalMin: 7, unit: "kg" },
+        range: { max: 25, min: 5, minKind: "clinical", optimalMax: 18, optimalMin: 7, unit: "kg" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 30, min: 8, optimalMax: 22, optimalMin: 10, unit: "kg" },
+        range: { max: 30, min: 8, minKind: "clinical", optimalMax: 22, optimalMin: 10, unit: "kg" },
         sex: "F"
       }
     ]
   },
   GynoidFatPct: {
-    default: { max: 45, min: 15, optimalMax: 35, optimalMin: 20, unit: "%" },
+    default: { max: 45, min: 15, minKind: "display", optimalMax: 35, optimalMin: 20, unit: "%" },
     direction: "lower-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 35, min: 12, optimalMax: 28, optimalMin: 15, unit: "%" },
+        range: { max: 35, min: 12, minKind: "display", optimalMax: 28, optimalMin: 15, unit: "%" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 50, min: 20, optimalMax: 40, optimalMin: 25, unit: "%" },
+        range: { max: 50, min: 20, minKind: "display", optimalMax: 40, optimalMin: 25, unit: "%" },
         sex: "F"
       }
     ]
   },
   LeanMass: {
-    default: { max: 75, min: 35, optimalMax: 65, optimalMin: 40, unit: "kg" },
+    default: { max: 75, maxKind: "display", min: 35, optimalMax: 65, optimalMin: 40, unit: "kg" },
     direction: "higher-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 85, min: 45, optimalMax: 75, optimalMin: 50, unit: "kg" },
+        range: { max: 85, maxKind: "display", min: 45, optimalMax: 75, optimalMin: 50, unit: "kg" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 55, min: 30, optimalMax: 48, optimalMin: 35, unit: "kg" },
+        range: { max: 55, maxKind: "display", min: 30, optimalMax: 48, optimalMin: 35, unit: "kg" },
         sex: "F"
       }
     ]
   },
   TotalMass: {
     default: { max: 100, min: 50, optimalMax: 85, optimalMin: 55, unit: "kg" },
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
@@ -6510,226 +6487,856 @@ var biomarkerRangeDefinitions = {
       }
     ]
   },
-  VATMass: {
-    default: { max: 1.5, min: 0, optimalMax: 0.8, optimalMin: 0, unit: "kg" },
-    direction: "lower-better",
-    source: "ofenheimer-vat-2020",
+  VATMass: {
+    default: { max: 1.5, min: 0, optimalMax: 0.8, optimalMin: 0, unit: "kg" },
+    direction: "lower-better",
+    kind: "population",
+    source: "ofenheimer-vat-2020",
+    variants: [
+      {
+        ageMin: 18,
+        range: { max: 1.5, min: 0, optimalMax: 1, optimalMin: 0, unit: "kg" },
+        sex: "M"
+      },
+      {
+        ageMin: 18,
+        range: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "kg" },
+        sex: "F"
+      }
+    ]
+  },
+  VATVolume: {
+    default: {
+      max: 852,
+      min: 0,
+      optimalMax: 600,
+      optimalMin: 0,
+      unit: "cm\xB3",
+      warningMax: 1837
+    },
+    direction: "lower-better",
+    kind: "decision-threshold",
+    source: "ge-corescan"
+  },
+  BMD_Total: {
+    default: {
+      max: 1.4,
+      maxKind: "display",
+      min: 0.9,
+      optimalMax: 1.3,
+      optimalMin: 1,
+      unit: "g/cm\xB2"
+    },
+    direction: "higher-better",
+    kind: "decision-threshold",
+    source: "who-osteoporosis-1994"
+  },
+  TScore_Total: {
+    default: {
+      max: 4,
+      maxKind: "display",
+      min: -1,
+      optimalMax: 2,
+      optimalMin: -0.5,
+      unit: ""
+    },
+    direction: "higher-better",
+    kind: "decision-threshold",
+    source: "who-osteoporosis-1994"
+  },
+  ZScore_Total: {
+    default: {
+      max: 2,
+      maxKind: "display",
+      min: -2,
+      optimalMax: 1,
+      optimalMin: -1,
+      unit: ""
+    },
+    direction: "higher-better",
+    kind: "decision-threshold",
+    source: "who-osteoporosis-1994"
+  },
+  Amylase: {
+    default: { max: 100, min: 28, optimalMax: 90, optimalMin: 35, unit: "U/L" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  Creatinine_Urine: {
+    default: { max: 300, min: 20, optimalMax: 250, optimalMin: 40, unit: "mg/dL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
+    variants: [
+      {
+        ageMin: 18,
+        range: { max: 300, min: 40, optimalMax: 260, optimalMin: 60, unit: "mg/dL" },
+        sex: "M"
+      },
+      {
+        ageMin: 18,
+        range: { max: 220, min: 20, optimalMax: 180, optimalMin: 40, unit: "mg/dL" },
+        sex: "F"
+      }
+    ]
+  },
+  IgA: {
+    default: { max: 400, min: 70, optimalMax: 350, optimalMin: 100, unit: "mg/dL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  Lipase: {
+    default: { max: 60, min: 0, optimalMax: 50, optimalMin: 10, unit: "U/L" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  Microalbumin_Urine: {
+    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/L" },
+    kind: "decision-threshold",
+    source: "kdigo-ckd-2024"
+  },
+  PSA_Free: {
+    default: { max: 1.5, min: 0, optimalMax: 1, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
+    source: "sturgeon-nacb-2008"
+  },
+  // Relação PSA livre/total — `higher-better`: razão maior = menor risco de
+  // câncer de próstata, logo não há limite superior "ruim" (acima do normal é
+  // verde). Faixas alinhadas à tabela clínica: ≥25% baixo risco (verde),
+  // 10–25% atenção — intermediário/moderado (âmbar), <10% alto risco >50%
+  // (vermelho). Limites: `min` (25) é o piso do verde e `warningMin` (10) o
+  // piso do âmbar — o vermelho é estritamente abaixo de 10% (< 10%); 10%
+  // pertence ao âmbar, conforme a faixa "10–15% moderado" da tabela.
+  PSA_FreeRatio: {
+    default: {
+      max: 100,
+      maxKind: "display",
+      min: 25,
+      optimalMax: 100,
+      optimalMin: 30,
+      unit: "%",
+      warningMin: 10
+    },
+    direction: "higher-better",
+    kind: "decision-threshold",
+    source: "sturgeon-nacb-2008"
+  },
+  // BMI - WHO classification: 18.5–24.9 normal, 25–29.9 overweight, ≥30 obese
+  BMI: {
+    default: { max: 30, min: 18.5, optimalMax: 24.9, optimalMin: 18.5, unit: "kg/m2" },
+    kind: "decision-threshold",
+    source: "who-obesity-2000"
+  },
+  // eAG — Estimated Average Glucose, derivada da HbA1c pela fórmula ADAG:
+  // eAG (mg/dL) = 28,7 × HbA1c(%) − 46,7 (NATHAN, D. M. et al. Translating the
+  // A1C assay into estimated average glucose values. Diabetes Care, v. 31, n. 8,
+  // p. 1473-1478, 2008. DOI: 10.2337/dc08-0545).
+  //
+  // As faixas espelham os cortes diagnósticos de HbA1c da SBD (ver entrada
+  // `HbA1c`) convertidos por essa fórmula, mantendo a eAG coerente com o
+  // marcador de origem:
+  //   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: 11,
+      minKind: "display",
+      optimalMax: 105,
+      optimalMin: 82,
+      unit: "mg/dL",
+      warningMax: 137
+    },
+    kind: "decision-threshold",
+    source: "sbd-diabetes-2024"
+  },
+  // INR - International Normalized Ratio (non-anticoagulated patients)
+  INR: {
+    default: { max: 1.2, min: 0.8, optimalMax: 1.1, optimalMin: 0.9, unit: "ratio" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  // Prothrombin Time
+  ProthrombinTime: {
+    default: { max: 13.5, min: 11, optimalMax: 13, optimalMin: 11, unit: "seconds" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  // DHT - Dihydrotestosterone (adult male reference; female values are much lower)
+  DHT: {
+    default: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: "ng/dL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
     variants: [
       {
         ageMin: 18,
-        range: { max: 1.5, min: 0, optimalMax: 1, optimalMin: 0, unit: "kg" },
+        range: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: "ng/dL" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "kg" },
+        range: { max: 22, min: 4, optimalMax: 22, optimalMin: 4, unit: "ng/dL" },
         sex: "F"
       }
     ]
   },
-  VATVolume: {
-    default: {
-      max: 852,
-      min: 0,
-      optimalMax: 600,
-      optimalMin: 0,
-      unit: "cm\xB3",
-      warningMax: 1837
-    },
+  // Total IgE - higher values suggest atopy/allergic sensitization
+  IgE_Total: {
+    default: { max: 100, min: 0, optimalMax: 100, optimalMin: 0, unit: "IU/mL" },
     direction: "lower-better",
-    source: "ge-corescan"
-  },
-  BMD_Total: {
-    default: { max: 1.4, min: 0.9, optimalMax: 1.3, optimalMin: 1, unit: "g/cm\xB2" },
-    direction: "higher-better",
-    source: "who-osteoporosis-1994"
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
   },
-  TScore_Total: {
-    default: { max: 4, min: -1, optimalMax: 2, optimalMin: -0.5, unit: "" },
-    direction: "higher-better",
-    source: "who-osteoporosis-1994"
+  // IgG - Immunoglobulin G
+  IgG: {
+    default: { max: 1600, min: 700, optimalMax: 1600, optimalMin: 700, unit: "mg/dL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
   },
-  ZScore_Total: {
-    default: { max: 2, min: -2, optimalMax: 1, optimalMin: -1, unit: "" },
-    direction: "higher-better",
-    source: "who-osteoporosis-1994"
+  // IgE E1 Cat Dander - Class 0 (≤0.35 kU/L) = negative
+  IgE_E1_CatDander: {
+    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: "kU/L" },
+    direction: "lower-better",
+    kind: "decision-threshold",
+    source: "tietz-7ed-2015"
   },
-  Amylase: {
-    default: { max: 100, min: 28, optimalMax: 90, optimalMin: 35, unit: "U/L" },
+  // IgE GX1 Grasses - Class 0 (≤0.35 kU/L) = negative
+  IgE_GX1_Grasses: {
+    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: "kU/L" },
+    direction: "lower-better",
+    kind: "decision-threshold",
     source: "tietz-7ed-2015"
+  }
+};
+var defaultReferenceRanges = Object.fromEntries(
+  Object.entries(biomarkerRangeDefinitions).map(([code, def]) => [
+    code,
+    {
+      ...def.default,
+      ...def.kind && { kind: def.kind },
+      ...def.source && { source: def.source }
+    }
+  ])
+);
+function getReferenceRange(testCode, context) {
+  const definition = biomarkerRangeDefinitions[testCode];
+  if (!definition) return void 0;
+  const withSource = (range2, kind = definition.kind) => ({
+    ...range2,
+    ...kind && { kind },
+    ...definition.source && { source: definition.source }
+  });
+  if (!context || !definition.variants || definition.variants.length === 0) {
+    return withSource(definition.default);
+  }
+  const { age, biologicalSex, pregnancyTrimester, pregnant } = context;
+  const hasPregnancyVariant = definition.variants.some((v) => v.pregnant === true);
+  for (const variant of definition.variants) {
+    if (variant.pregnant === true) {
+      if (!pregnant) continue;
+      if (variant.pregnancyTrimester !== void 0 && variant.pregnancyTrimester !== pregnancyTrimester) {
+        continue;
+      }
+    } else if (pregnant && hasPregnancyVariant) {
+      continue;
+    }
+    if (variant.sex !== "all" && variant.sex !== biologicalSex) {
+      continue;
+    }
+    if (variant.ageMin !== void 0 && (age === void 0 || age < variant.ageMin)) {
+      continue;
+    }
+    if (variant.ageMax !== void 0 && (age === void 0 || age > variant.ageMax)) {
+      continue;
+    }
+    return withSource(variant.range, variant.kind ?? definition.kind);
+  }
+  return withSource(definition.default);
+}
+function getRangeDirection(testCode) {
+  return biomarkerRangeDefinitions[testCode]?.direction ?? "range";
+}
+function referenceRangeMeaning(kind) {
+  const system = "http://terminology.hl7.org/CodeSystem/referencerange-meaning";
+  if (kind === "reference-interval") return { code: "normal", display: "Normal Range", system };
+  if (kind === "decision-threshold") {
+    return { code: "recommended", display: "Recommended Range", system };
+  }
+  return void 0;
+}
+
+// src/converter.ts
+function interpretationCode(flag) {
+  switch (flag) {
+    case "H":
+      return "H";
+    // High
+    case "L":
+      return "L";
+    // Low
+    default:
+      return "N";
+  }
+}
+function interpretationDisplay(flag) {
+  switch (flag) {
+    case "H":
+      return "High";
+    case "L":
+      return "Low";
+    default:
+      return "Normal";
+  }
+}
+var SEX_CODING = {
+  female: {
+    code: "female",
+    display: "Female",
+    system: "http://hl7.org/fhir/administrative-gender"
   },
-  Creatinine_Urine: {
-    default: { max: 300, min: 20, optimalMax: 250, optimalMin: 40, unit: "mg/dL" },
-    source: "tietz-7ed-2015",
-    variants: [
+  male: { code: "male", display: "Male", system: "http://hl7.org/fhir/administrative-gender" }
+};
+var buildReferenceRanges = (observation, quantity) => {
+  const toRanges = (low, high, sex) => {
+    if (low === void 0 && high === void 0) return [];
+    return [
       {
-        ageMin: 18,
-        range: { max: 300, min: 40, optimalMax: 260, optimalMin: 60, unit: "mg/dL" },
-        sex: "M"
-      },
+        ...sex === void 0 ? {} : { appliesTo: [{ coding: [SEX_CODING[sex]] }] },
+        ...high === void 0 ? {} : { high: quantity(high) },
+        ...low === void 0 ? {} : { low: quantity(low) }
+      }
+    ];
+  };
+  if (observation.referenceRanges && observation.referenceRanges.length > 0) {
+    return observation.referenceRanges.flatMap((r) => toRanges(r.low, r.high, r.appliesTo));
+  }
+  const meaning = observation.referenceKind && referenceRangeMeaning(observation.referenceKind);
+  return toRanges(observation.referenceMin, observation.referenceMax).map(
+    (range2) => meaning ? { ...range2, type: { coding: [meaning] } } : range2
+  );
+};
+function labObservationToFHIR(observation, patientId, laboratoryName) {
+  const loincCode = codeToLoinc(observation.biomarkerCode);
+  const sourceUnit = observation.unit || getDefaultUnit(observation.biomarkerCode) || observation.unit;
+  const ucumUnit = resolveUcum(sourceUnit, observation.biomarkerCode);
+  const quantity = (value) => ({
+    ...ucumUnit ? { code: ucumUnit, system: "http://unitsofmeasure.org" } : {},
+    ...sourceUnit ? { unit: sourceUnit } : {},
+    value
+  });
+  const isQualitative = observation.isQualitative || typeof observation.value === "string";
+  const fhirObs = {
+    category: [
+      {
+        coding: [
+          {
+            code: "laboratory",
+            display: "Laboratory",
+            system: "http://terminology.hl7.org/CodeSystem/observation-category"
+          }
+        ]
+      }
+    ],
+    code: {
+      // Sem LOINC, o coding LOINC simplesmente não sai. Antes ia `99999-9`,
+      // que não é código LOINC nenhum: publicava sob `http://loinc.org` uma
+      // afirmação falsa, e quem consumisse o bundle confiando no system
+      // trataria aquilo como código de verdade. Composição corporal, densidade
+      // óssea e escore de cálcio não têm LOINC, e o certo é a lacuna explícita.
+      coding: [
+        ...loincCode ? [
+          {
+            code: loincCode,
+            display: observation.biomarkerName,
+            system: LOINC_SYSTEM
+          }
+        ] : [],
+        {
+          code: observation.biomarkerCode,
+          display: observation.biomarkerName,
+          system: BIOMARKER_CODE_SYSTEM
+        }
+      ],
+      text: observation.biomarkerName
+    },
+    effectiveDateTime: observation.collectionDate,
+    id: `${observation.reportId}-${observation.biomarkerCode}`,
+    interpretation: [
+      {
+        coding: [
+          {
+            code: interpretationCode(observation.flag),
+            display: interpretationDisplay(observation.flag),
+            system: "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
+          }
+        ]
+      }
+    ],
+    performer: laboratoryName ? [{ display: laboratoryName }] : void 0,
+    resourceType: "Observation",
+    status: "final",
+    subject: {
+      reference: `Patient/${patientId}`
+    }
+  };
+  if (isQualitative) {
+    fhirObs.valueString = String(observation.value);
+  } else {
+    fhirObs.valueQuantity = quantity(observation.value);
+    const referenceRange = buildReferenceRanges(observation, quantity);
+    if (referenceRange.length > 0) fhirObs.referenceRange = referenceRange;
+  }
+  return fhirObs;
+}
+function labReportToFHIR(report, patientId, observationIds) {
+  let status;
+  switch (report.processingStatus) {
+    case "complete":
+      status = "final";
+      break;
+    case "partial":
+      status = "partial";
+      break;
+    case "pending_review":
+      status = "preliminary";
+      break;
+    default:
+      status = "final";
+  }
+  return {
+    category: [
+      {
+        coding: [
+          {
+            code: "LAB",
+            display: "Laboratory",
+            system: "http://terminology.hl7.org/CodeSystem/v2-0074"
+          }
+        ]
+      }
+    ],
+    code: {
+      coding: [
+        {
+          code: "11502-2",
+          // Laboratory report
+          display: "Laboratory report",
+          system: "http://loinc.org"
+        }
+      ],
+      text: "Laboratory Results"
+    },
+    conclusion: report.overallStatus === "NORMAL" ? "All results within normal limits" : "One or more abnormal results detected",
+    conclusionCode: report.overallStatus === "ANORMAL" ? [
       {
-        ageMin: 18,
-        range: { max: 220, min: 20, optimalMax: 180, optimalMin: 40, unit: "mg/dL" },
-        sex: "F"
+        coding: [
+          {
+            code: "A",
+            display: "Abnormal",
+            system: "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
+          }
+        ]
       }
-    ]
-  },
-  IgA: {
-    default: { max: 400, min: 70, optimalMax: 350, optimalMin: 100, unit: "mg/dL" },
-    source: "tietz-7ed-2015"
-  },
-  Lipase: {
-    default: { max: 60, min: 0, optimalMax: 50, optimalMin: 10, unit: "U/L" },
-    source: "tietz-7ed-2015"
-  },
-  Microalbumin_Urine: {
-    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/L" },
-    source: "kdigo-ckd-2024"
-  },
-  PSA_Free: {
-    default: { max: 1.5, min: 0, optimalMax: 1, optimalMin: 0, unit: "ng/mL" },
-    source: "sturgeon-nacb-2008"
-  },
-  // Relação PSA livre/total — `higher-better`: razão maior = menor risco de
-  // câncer de próstata, logo não há limite superior "ruim" (acima do normal é
-  // verde). Faixas alinhadas à tabela clínica: ≥25% baixo risco (verde),
-  // 10–25% atenção — intermediário/moderado (âmbar), <10% alto risco >50%
-  // (vermelho). Limites: `min` (25) é o piso do verde e `warningMin` (10) o
-  // piso do âmbar — o vermelho é estritamente abaixo de 10% (< 10%); 10%
-  // pertence ao âmbar, conforme a faixa "10–15% moderado" da tabela.
-  PSA_FreeRatio: {
-    default: { max: 100, min: 25, optimalMax: 100, optimalMin: 30, unit: "%", warningMin: 10 },
-    direction: "higher-better",
-    source: "sturgeon-nacb-2008"
-  },
-  // BMI - WHO classification: 18.5–24.9 normal, 25–29.9 overweight, ≥30 obese
-  BMI: {
-    default: { max: 30, min: 18.5, optimalMax: 24.9, optimalMin: 18.5, unit: "kg/m2" },
-    source: "who-obesity-2000"
-  },
-  // eAG — Estimated Average Glucose, derivada da HbA1c pela fórmula ADAG:
-  // eAG (mg/dL) = 28,7 × HbA1c(%) − 46,7 (NATHAN, D. M. et al. Translating the
-  // A1C assay into estimated average glucose values. Diabetes Care, v. 31, n. 8,
-  // p. 1473-1478, 2008. DOI: 10.2337/dc08-0545).
-  //
-  // As faixas espelham os cortes diagnósticos de HbA1c da SBD (ver entrada
-  // `HbA1c`) convertidos por essa fórmula, mantendo a eAG coerente com o
-  // marcador de origem:
-  //   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: 11, optimalMax: 105, optimalMin: 82, unit: "mg/dL", warningMax: 137 },
-    source: "sbd-diabetes-2024"
-  },
-  // INR - International Normalized Ratio (non-anticoagulated patients)
-  INR: {
-    default: { max: 1.2, min: 0.8, optimalMax: 1.1, optimalMin: 0.9, unit: "ratio" },
-    source: "tietz-7ed-2015"
-  },
-  // Prothrombin Time
-  ProthrombinTime: {
-    default: { max: 13.5, min: 11, optimalMax: 13, optimalMin: 11, unit: "seconds" },
-    source: "tietz-7ed-2015"
-  },
-  // DHT - Dihydrotestosterone (adult male reference; female values are much lower)
-  DHT: {
-    default: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: "ng/dL" },
-    source: "tietz-7ed-2015",
-    variants: [
+    ] : void 0,
+    effectiveDateTime: report.collectionDate,
+    id: report.reportId,
+    issued: report.createdAt,
+    performer: report.laboratoryName ? [{ display: report.laboratoryName }] : void 0,
+    resourceType: "DiagnosticReport",
+    result: observationIds.map((id) => ({ reference: `Observation/${id}` })),
+    status,
+    subject: {
+      reference: `Patient/${patientId}`
+    }
+  };
+}
+function userProfileToFHIR(profile) {
+  const nameParts = profile.name.split(" ");
+  const given = nameParts.slice(0, -1);
+  const family = nameParts[nameParts.length - 1] || "";
+  return {
+    address: profile.address ? [
       {
-        ageMin: 18,
-        range: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: "ng/dL" },
-        sex: "M"
-      },
+        city: profile.address.city,
+        country: profile.address.country || "BR",
+        line: [
+          profile.address.street && profile.address.number ? `${profile.address.street}, ${profile.address.number}` : profile.address.street,
+          profile.address.complement
+        ].filter(Boolean),
+        postalCode: profile.address.postalCode,
+        state: profile.address.state
+      }
+    ] : void 0,
+    birthDate: profile.birthDate,
+    gender: profile.gender,
+    id: profile.userId,
+    name: [
       {
-        ageMin: 18,
-        range: { max: 22, min: 4, optimalMax: 22, optimalMin: 4, unit: "ng/dL" },
-        sex: "F"
+        family,
+        given: given.length > 0 ? given : void 0,
+        text: profile.name
       }
-    ]
-  },
-  // Total IgE - higher values suggest atopy/allergic sensitization
-  IgE_Total: {
-    default: { max: 100, min: 0, optimalMax: 100, optimalMin: 0, unit: "IU/mL" },
-    direction: "lower-better",
-    source: "tietz-7ed-2015"
-  },
-  // IgG - Immunoglobulin G
-  IgG: {
-    default: { max: 1600, min: 700, optimalMax: 1600, optimalMin: 700, unit: "mg/dL" },
-    source: "tietz-7ed-2015"
-  },
-  // IgE E1 Cat Dander - Class 0 (≤0.35 kU/L) = negative
-  IgE_E1_CatDander: {
-    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: "kU/L" },
-    direction: "lower-better",
-    source: "tietz-7ed-2015"
-  },
-  // IgE GX1 Grasses - Class 0 (≤0.35 kU/L) = negative
-  IgE_GX1_Grasses: {
-    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: "kU/L" },
-    direction: "lower-better",
-    source: "tietz-7ed-2015"
+    ],
+    resourceType: "Patient",
+    telecom: [
+      ...profile.email ? [{ system: "email", value: profile.email }] : [],
+      ...profile.phone ? [{ system: "phone", value: profile.phone }] : []
+    ].length > 0 ? [
+      ...profile.email ? [{ system: "email", value: profile.email }] : [],
+      ...profile.phone ? [{ system: "phone", value: profile.phone }] : []
+    ] : void 0
+  };
+}
+function labResultToFHIRBundle(report, observations, userProfile) {
+  const patientId = userProfile.userId;
+  const fhirObservations = observations.map((obs) => {
+    const resource = labObservationToFHIR(
+      { ...obs, collectionDate: report.collectionDate },
+      patientId,
+      report.laboratoryName
+    );
+    return { fullUrl: entryFullUrl(resource), resource };
+  });
+  const observationIds = fhirObservations.map((entry) => entry.resource.id);
+  const diagnosticReport = labReportToFHIR(report, patientId, observationIds);
+  const fhirPatient = userProfileToFHIR(userProfile);
+  return {
+    entry: [
+      { fullUrl: entryFullUrl(fhirPatient), resource: fhirPatient },
+      { fullUrl: entryFullUrl(diagnosticReport), resource: diagnosticReport },
+      ...fhirObservations
+    ],
+    resourceType: "Bundle",
+    type: "collection"
+  };
+}
+
+// src/cli/commands/convert.ts
+async function convert(args, json) {
+  const raw = await getInput(args[0]);
+  const data = parseJson(
+    raw,
+    "JSON inv\xE1lido. Forne\xE7a um objeto com { report, observations, profile }."
+  );
+  if (!data.report || !data.observations || !data.profile) {
+    exitWithError(
+      'Formato esperado: { "report": LabReportData, "observations": LabObservationData[], "profile": UserProfileData }'
+    );
   }
-};
-var defaultReferenceRanges = Object.fromEntries(
-  Object.entries(biomarkerRangeDefinitions).map(([code, def]) => [
-    code,
-    def.source ? { ...def.default, source: def.source } : def.default
-  ])
-);
-function getReferenceRange(testCode, context) {
-  const definition = biomarkerRangeDefinitions[testCode];
-  if (!definition) return void 0;
-  const withSource = (range2) => definition.source ? { ...range2, source: definition.source } : range2;
-  if (!context || !definition.variants || definition.variants.length === 0) {
-    return withSource(definition.default);
+  const bundle = labResultToFHIRBundle(data.report, data.observations, data.profile);
+  if (json) {
+    outputJson(bundle);
+  } else {
+    outputText(JSON.stringify(bundle, null, 2));
+  }
+}
+
+// src/validators.ts
+function validateFHIRImportBundle(data) {
+  const errors = [];
+  if (!data || typeof data !== "object") {
+    errors.push({ details: "Input must be a JSON object", field: "root" });
+    return errors;
+  }
+  const bundle = data;
+  if (bundle.resourceType !== "Bundle") {
+    errors.push({
+      details: `Expected resourceType "Bundle", got "${String(bundle.resourceType)}"`,
+      field: "resourceType"
+    });
+  }
+  if (!Array.isArray(bundle.entry)) {
+    errors.push({ details: 'Bundle must contain an "entry" array', field: "entry" });
+  } else if (bundle.entry.length === 0) {
+    errors.push({ details: "Bundle entry array is empty", field: "entry" });
+  }
+  return errors;
+}
+
+// src/importer.ts
+var MAX_OBSERVATIONS = 5e3;
+var MAX_FILE_SIZE = 15 * 1024 * 1024;
+function resolveBiomarkerCode(observation) {
+  const coding = observation.code?.coding ?? [];
+  const loincCode = coding.find((c) => c.system === LOINC_SYSTEM)?.code;
+  const declaredCode = coding.find((c) => c.system === BIOMARKER_CODE_SYSTEM)?.code;
+  const seenCodes = [
+    ...loincCode ? [`LOINC ${loincCode}`] : [],
+    ...declaredCode ? [`biomarker code ${declaredCode}`] : []
+  ];
+  let reason;
+  if (seenCodes.length > 0) {
+    reason = `Unknown code: ${seenCodes.join(", ")}`;
+  } else if (coding.length > 0) {
+    const systems = [...new Set(coding.map((c) => c.system ?? "(sem system)"))];
+    reason = `No code in a supported system (found: ${systems.join(", ")})`;
+  } else {
+    reason = "No code found in observation coding";
   }
-  const { age, biologicalSex, pregnancyTrimester, pregnant } = context;
-  const hasPregnancyVariant = definition.variants.some((v) => v.pregnant === true);
-  for (const variant of definition.variants) {
-    if (variant.pregnant === true) {
-      if (!pregnant) continue;
-      if (variant.pregnancyTrimester !== void 0 && variant.pregnancyTrimester !== pregnancyTrimester) {
-        continue;
-      }
-    } else if (pregnant && hasPregnancyVariant) {
+  const fromLoinc = loincCode ? loincToCode(loincCode) : void 0;
+  if (fromLoinc) return { internalCode: fromLoinc, loincCode, reason };
+  if (declaredCode && isValidCode(declaredCode)) {
+    const canonical = normalizeCode(declaredCode);
+    return { internalCode: canonical, loincCode: codeToLoinc(canonical), reason };
+  }
+  return { loincCode, reason };
+}
+function extractFlag(observation) {
+  const code = observation.interpretation?.[0]?.coding?.[0]?.code;
+  if (code === "H" || code === "HH") return "H";
+  if (code === "L" || code === "LL") return "L";
+  return "";
+}
+function extractObservationsFromBundle(bundle) {
+  const observations = [];
+  const skipped = [];
+  for (let i = 0; i < bundle.entry.length; i++) {
+    const entry = bundle.entry[i];
+    if (!entry.resource) {
+      skipped.push({ index: i, reason: "Entry has no resource" });
       continue;
     }
-    if (variant.sex !== "all" && variant.sex !== biologicalSex) {
+    if (entry.resource.resourceType !== "Observation") {
       continue;
     }
-    if (variant.ageMin !== void 0 && (age === void 0 || age < variant.ageMin)) {
+    if (observations.length >= MAX_OBSERVATIONS) {
+      skipped.push({ index: i, reason: `Maximum of ${MAX_OBSERVATIONS} observations exceeded` });
       continue;
     }
-    if (variant.ageMax !== void 0 && (age === void 0 || age > variant.ageMax)) {
-      continue;
+    observations.push(entry.resource);
+  }
+  return { observations, skipped };
+}
+function mapFHIRObservationToInternal(observation, index) {
+  const { internalCode, loincCode, reason } = resolveBiomarkerCode(observation);
+  if (!internalCode) {
+    return {
+      skipped: { index, loincCode, reason, resourceType: "Observation" }
+    };
+  }
+  const definition = getDefinitionByCode(internalCode);
+  let value;
+  let unit = "";
+  let isQualitative = false;
+  if (observation.valueQuantity?.value !== void 0) {
+    value = observation.valueQuantity.value;
+    unit = observation.valueQuantity.unit || observation.valueQuantity.code || "";
+  } else if (observation.valueString) {
+    value = observation.valueString;
+    isQualitative = true;
+  } else {
+    return {
+      skipped: {
+        index,
+        loincCode,
+        reason: "Observation has no value (valueQuantity or valueString)",
+        resourceType: "Observation"
+      }
+    };
+  }
+  const collectionDate = observation.effectiveDateTime || observation.effectivePeriod?.start || "";
+  if (!collectionDate) {
+    return {
+      skipped: {
+        index,
+        loincCode,
+        reason: "Observation has no effectiveDateTime or effectivePeriod.start",
+        resourceType: "Observation"
+      }
+    };
+  }
+  let referenceMin;
+  let referenceMax;
+  let referenceKind;
+  if (observation.referenceRange?.[0]) {
+    referenceMin = observation.referenceRange[0].low?.value;
+    referenceMax = observation.referenceRange[0].high?.value;
+    const meaning = observation.referenceRange[0].type?.coding?.find(
+      (c) => c.system === "http://terminology.hl7.org/CodeSystem/referencerange-meaning"
+    )?.code;
+    if (meaning === "normal") referenceKind = "reference-interval";
+    else if (meaning === "recommended") referenceKind = "decision-threshold";
+  }
+  const imported = {
+    biomarkerCode: internalCode,
+    biomarkerName: definition?.names.pt[0] || definition?.names.en[0] || observation.code.text || internalCode,
+    collectionDate,
+    flag: extractFlag(observation),
+    isQualitative,
+    loincCode,
+    ...referenceKind && { referenceKind },
+    referenceMax,
+    referenceMin,
+    unit: unit || definition?.unit || "",
+    value
+  };
+  return { observation: imported };
+}
+function processImportBundle(data) {
+  const validationErrors = validateFHIRImportBundle(data);
+  if (validationErrors.length > 0) {
+    return {
+      errors: validationErrors,
+      imported: [],
+      skipped: [],
+      totalProcessed: 0
+    };
+  }
+  const bundle = data;
+  const { observations, skipped } = extractObservationsFromBundle(bundle);
+  const imported = [];
+  const allSkipped = [...skipped];
+  for (let i = 0; i < observations.length; i++) {
+    const result = mapFHIRObservationToInternal(observations[i], i);
+    if ("observation" in result) {
+      imported.push(result.observation);
+    } else {
+      allSkipped.push(result.skipped);
     }
-    return withSource(variant.range);
   }
-  return withSource(definition.default);
+  return {
+    errors: [],
+    imported,
+    skipped: allSkipped,
+    totalProcessed: observations.length
+  };
 }
-function getRangeDirection(testCode) {
-  return biomarkerRangeDefinitions[testCode]?.direction ?? "range";
+
+// src/cli/commands/import.ts
+async function importBundle(args, json) {
+  const raw = await getInput(args[0]);
+  const bundle = parseJson(raw, "JSON inv\xE1lido.");
+  const result = processImportBundle(bundle);
+  if (json) {
+    outputJson(result);
+    return;
+  }
+  outputText(`Processados: ${result.totalProcessed}`);
+  outputText(`Importados:  ${result.imported.length}`);
+  outputText(`Ignorados:   ${result.skipped.length}`);
+  outputText(`Erros:       ${result.errors.length}`);
+  if (result.imported.length > 0) {
+    outputText("\nObserva\xE7\xF5es importadas:");
+    for (const obs of result.imported) {
+      outputText(`  ${obs.biomarkerCode} (${obs.loincCode}): ${obs.value} ${obs.unit}`);
+    }
+  }
+  if (result.errors.length > 0) {
+    outputText("\nErros:");
+    for (const err of result.errors) {
+      outputText(`  ${err.field}: ${err.details}`);
+    }
+  }
+}
+
+// src/cli/commands/list.ts
+import { parseArgs } from "util";
+async function list(args, json) {
+  const { values } = parseArgs({
+    args,
+    options: {
+      category: { type: "string" },
+      visible: { default: false, type: "boolean" }
+    },
+    strict: false
+  });
+  let defs;
+  if (values.category) {
+    defs = getBiomarkersByCategory(values.category);
+    if (defs.length === 0) {
+      exitWithError(`Categoria n\xE3o encontrada ou vazia: ${values.category}`);
+    }
+  } else if (values.visible) {
+    defs = getVisibleDefinitions();
+  } else {
+    defs = getAllDefinitions();
+  }
+  if (json) {
+    outputJson(defs);
+    return;
+  }
+  const rows = defs.map((d) => [
+    d.code,
+    d.loinc ?? "\u2014",
+    d.names.pt[0] ?? "",
+    d.unit ?? "\u2014",
+    Array.isArray(d.category) ? d.category.join(", ") : d.category
+  ]);
+  outputText(formatTable(["C\xF3digo", "LOINC", "Nome (pt)", "Unidade", "Categoria"], rows));
+  outputText(`
+Total: ${defs.length} biomarcadores`);
+}
+
+// src/cli/commands/loinc-map.ts
+async function loincMap(_args, json) {
+  const defs = getAllDefinitions().filter((d) => d.loinc);
+  if (json) {
+    const map = Object.fromEntries(defs.map((d) => [d.loinc, d.code]));
+    outputJson(map);
+    return;
+  }
+  const rows = defs.map((d) => [d.loinc, d.code, d.names.pt[0] ?? d.names.en[0] ?? ""]);
+  outputText(formatTable(["LOINC", "C\xF3digo", "Nome (pt)"], rows));
+  outputText(`
+Total: ${rows.length} mapeamentos`);
+}
+
+// src/cli/commands/lookup.ts
+function displayDefinition(def) {
+  const cat = Array.isArray(def.category) ? def.category.join(", ") : def.category;
+  outputText(
+    [
+      `Biomarcador: ${def.code}`,
+      `  LOINC:      ${def.loinc ?? "\u2014"}`,
+      `  Nomes (pt): ${def.names.pt.join(", ")}`,
+      `  Nomes (en): ${def.names.en.join(", ")}`,
+      `  Categoria:  ${cat}`,
+      `  Unidade:    ${def.unit ?? "\u2014"}`,
+      `  Sexo:       ${def.sex ?? "ambos"}`,
+      `  Vis\xEDvel:    ${def.hidden ? "n\xE3o" : "sim"}`
+    ].join("\n")
+  );
+}
+async function lookup(args, json) {
+  const code = args[0];
+  if (!code) exitWithError("Uso: fhir-bio lookup <c\xF3digo>");
+  const def = getDefinitionByCode(code);
+  if (!def) exitWithError(`Biomarcador n\xE3o encontrado: ${code}`);
+  if (json) {
+    outputJson(def);
+  } else {
+    displayDefinition(def);
+  }
+}
+async function lookupLoinc(args, json) {
+  const loinc = args[0];
+  if (!loinc) exitWithError("Uso: fhir-bio lookup-loinc <loinc>");
+  const def = getDefinitionByLoinc(loinc);
+  if (!def) exitWithError(`Biomarcador n\xE3o encontrado para LOINC: ${loinc}`);
+  if (json) {
+    outputJson(def);
+  } else {
+    displayDefinition(def);
+  }
 }
 
 // src/cli/commands/range.ts
+import { parseArgs as parseArgs2 } from "util";
 async function range(args, json) {
   const { positionals, values } = parseArgs2({
     allowPositionals: true,
@@ -6766,11 +7373,18 @@ async function range(args, json) {
   const sexLabel = ctx.biologicalSex === "M" ? "Homem" : ctx.biologicalSex === "F" ? "Mulher" : "Geral";
   const ageLabel = ctx.age !== void 0 ? `, ${ctx.age} anos` : "";
   const fmt = (v) => v !== void 0 ? String(v) : "\u2014";
+  const desenho = (kind) => kind === "display" ? "  (desenho, n\xE3o \xE9 corte)" : "";
+  const tipos = {
+    "decision-threshold": "limiar de decis\xE3o",
+    population: "distribui\xE7\xE3o populacional",
+    "reference-interval": "intervalo de refer\xEAncia"
+  };
   outputText(
     [
       `Faixa de Refer\xEAncia: ${code} (${sexLabel}${ageLabel})`,
-      `  M\xEDnimo:       ${fmt(ref.min)} ${ref.unit}`,
-      `  M\xE1ximo:       ${fmt(ref.max)} ${ref.unit}`,
+      `  Tipo:         ${ref.kind ? tipos[ref.kind] : "\u2014"}`,
+      `  M\xEDnimo:       ${fmt(ref.min)} ${ref.unit}${desenho(ref.minKind)}`,
+      `  M\xE1ximo:       ${fmt(ref.max)} ${ref.unit}${desenho(ref.maxKind)}`,
       `  \xD3timo (m\xEDn):  ${fmt(ref.optimalMin)} ${ref.unit}`,
       `  \xD3timo (m\xE1x):  ${fmt(ref.optimalMax)} ${ref.unit}`,
       `  Alerta (m\xE1x): ${fmt(ref.warningMax)} ${ref.unit}`,
@@ -7263,7 +7877,7 @@ var COMMANDS = {
 async function main() {
   const { command, help, json, resto, version } = dividirArgv(process.argv.slice(2));
   if (version) {
-    process.stdout.write(`${"0.32.0"}
+    process.stdout.write(`${"0.34.0"}
 `);
     return;
   }