# Hyrimoz / vascular Behçet Laborkontrolle — Berichtworkflow

Use when Sir asks for a doctor-facing report on which blood/urine values to check around **Hyrimoz/Adalimumab**, **vascular Behçet**, thrombosis/thrombophlebitis, or Eliquis safety.

## Recommended report structure
1. **Kurzfazit**: objective disease control + medication safety, not generic lab dumping.
2. **Empfohlene Kontrollen with justification**:
   - CRP + BSG/ESR — inflammatory activity; vascular Behçet thrombosis is often inflammation-driven.
   - CBC/FBC with differential — infection, anemia/bleeding, leukopenia/neutropenia, platelets.
   - Liver panel: ALT/AST, GGT, AP, bilirubin — TNF-inhibitor and HBV/reactivation safety.
   - Kidney panel: creatinine, eGFR, urea, electrolytes — Eliquis safety and rare renal Behçet involvement.
   - Urine: dip/sediment for blood/protein/leukocytes plus albumin/creatinine and protein/creatinine ratios — renal involvement or bleeding signal.
   - TB/IGRA, HBV/HCV/HIV — baseline/confirmed before TNF blockade; repeat if exposure/symptoms/physician wants.
   - D-dimer/fibrinogen/factor VIII only targeted, not as routine reassurance markers.
   - Lipids + glucose/HbA1c — vascular risk management in systemic inflammation/steroid exposure.
3. **Aktuelle Werte from `/home/agent/Gesundheit/health_data.db`** with date, value, unit, reference, source note.
4. **Trend charts** grouped by: inflammation/blood count, kidney/urine, liver, lipids/metabolic, thrombosis markers.
5. **Concrete Arztfragen**: therapy goals, monitoring frequency, urine/kidney plan, TB/HBV/HCV/HIV confirmation, Eliquis criteria, lipid/CV risk, alarm plan.
6. **Sources** as short references, not long literature dumps.

## Data extraction pitfalls from current health DB
- Current HealthManager DB path for the live dashboard/newer uploads: `/home/agent/.hermes/assets/Gesundheit/health_data.db`. Older legacy copy `/home/agent/Gesundheit/health_data.db` can be stale and miss newer KSB/HealthManager values.
- `laborwerte.ermittlung_datum` is sometimes import time, not measurement date. Prefer explicit `abnahme_datum` when present; otherwise parse clinically meaningful dates from `bemerking` (`dd.mm.yyyy`) or PDF filenames (`yymmdd`) only when this is genuinely the measurement document, not a reference workbook upload date.
- The live DB may contain legacy/reference-XLSX artefact rows without `abnahme_datum`, `quelle`, or `dokument_id`; filter those out when a validated row for the same value exists, otherwise they can make old values look newer than they are.
- `laborwerte` may contain duplicate imports of the same PDF; de-duplicate by canonical parameter + measurement date + value + unit.
- Some rows have import artefacts where a date string appears in `wert`; exclude these from current-value display and numeric charts.
- Canonicalize aliases carefully: map `non-HDL` before `HDL`, otherwise non-HDL can be swallowed as HDL. Merge CRP aliases (`CRP`, `C-reaktives Protein`, `C-Reaktives Protein (CRP)`), liver aliases (`ALT/ALAT`, `AST/ASAT`), and D-dimer/D-dimere.
- Urine rows may be poorly labeled; use document context and date to distinguish urine leukocytes/albumin from blood leukocytes/serum albumin.

## Useful source anchors to cite
- Hatemi G et al. **2018 update of the EULAR recommendations for the management of Behçet’s syndrome**. Ann Rheum Dis. PMID: 29625968.
- Leccese P et al. **Management of major organ involvement of Behçet’s syndrome: systematic review for EULAR update**. PMID: 30107448.
- Emmi G et al. **Adalimumab-based treatment versus DMARDs for venous thrombosis in Behçet’s syndrome**. Arthritis Rheumatol. 2018. PMID: 29676522.
- Erol F et al. **Does anticoagulation in combination with immunosuppressive therapy prevent recurrent thrombosis in Behçet’s disease?** Clin Rheumatol. 2024. PMID: 38357865.
- EMA Hyrimoz EPAR/product information and FDA Humira prescribing information for TNF-blocker safety: serious infection, TB testing, HBV reactivation, malignancy and hematologic/hepatic warnings.
- NHS Specialist Pharmacy Service DOAC monitoring guidance: baseline/periodic FBC, liver and renal function; assess bleeding/anemia and renal-dose suitability.
- KDIGO CKD guidance: eGFR plus albuminuria/proteinuria ratios as core kidney damage markers.

## Output preference
- Doctor-facing PDF should be graphically clean, compact, and usable in consultation.
- Include a disclaimer that it is a Gesprächsgrundlage, not medical advice.
- Avoid raw database dumps or secrets; provide summarized tables and charts.