feat: BIO_NORMALS 33 analytes + interprétations cliniques + cohérence DAS/bio étendue

- BIO_NORMALS passe de 13 à 33 tests (cardio, infectio, métabo, thyroïde, hémato, hépatique)
- _BIO_INTERPRETATION synchronisé (33 entrées, 3 clés high/low/normal chacune)
- _DAS_BIO_CHECKS étendu de 13 à 38 patterns (sepsis, infarctus, EP, diabète, thyroïde, etc.)
- lab_value_sanity.yaml étendu avec 20 garde-fous plausibilité nouveaux tests
- tests/test_bio_normals.py : 32 tests (complétude, concordance, _is_abnormal)

Co-Authored-By: Claude Opus 4.6 <noreply@anthropic.com>

config/lab_value_sanity.yaml

@@ -60,3 +60,85 @@ tests:
   bilirubine totale:
     hard_min: 0
     hard_max: 2000
+
+  # --- Nouveaux tests (Phase 5) ---
+
+  bilirubine directe:
+    hard_min: 0
+    hard_max: 1000
+
+  ldh:
+    hard_min: 0
+    hard_max: 10000
+
+  vs:
+    hard_min: 0
+    hard_max: 200
+
+  tp:
+    hard_min: 0
+    hard_max: 150
+
+  tca:
+    hard_min: 10
+    hard_max: 200
+
+  ferritine:
+    hard_min: 0
+    hard_max: 100000    # surcharge massive possible (hémochromatose)
+
+  uree:
+    hard_min: 0
+    hard_max: 200
+
+  troponine:
+    hard_min: 0
+    hard_max: 1000
+
+  bnp:
+    hard_min: 0
+    hard_max: 50000
+
+  nt-probnp:
+    hard_min: 0
+    hard_max: 100000
+
+  d-dimeres:
+    hard_min: 0
+    hard_max: 100000
+
+  inr:
+    hard_min: 0.1
+    hard_max: 20
+
+  fibrinogene:
+    hard_min: 0
+    hard_max: 20
+
+  procalcitonine:
+    hard_min: 0
+    hard_max: 1000
+
+  lactate:
+    hard_min: 0
+    hard_max: 30
+
+  glycemie:
+    hard_min: 0
+    hard_max: 100
+
+  hba1c:
+    hard_min: 2
+    hard_max: 20
+
+  albumine:
+    hard_min: 0
+    hard_max: 100
+
+  acide urique:
+    hard_min: 0
+    hard_max: 2000
+
+  tsh:
+    hard_min: 0
+    hard_max: 500

src/control/cpam_context.py

@@ -165,18 +165,48 @@ def _build_tagged_context(dossier: DossierMedical) -> tuple[str, dict[str, str]]
 
 # Interprétations cliniques pour le résumé bio déterministe
 _BIO_INTERPRETATION: dict[str, dict[str, str]] = {
-    "CRP": {"high": "infection/inflammation active", "low": "normal", "normal": "pas d'inflammation"},
+    # --- Hépatique / digestif ---
-    "Hémoglobine": {"high": "polyglobulie", "low": "anémie", "normal": "pas d'anémie"},
-    "Plaquettes": {"high": "thrombocytose", "low": "thrombopénie", "normal": "numération normale"},
-    "Leucocytes": {"high": "hyperleucocytose", "low": "leucopénie", "normal": "numération normale"},
-    "Créatinine": {"high": "insuffisance rénale", "low": "normal", "normal": "fonction rénale conservée"},
-    "Potassium": {"high": "hyperkaliémie", "low": "hypokaliémie", "normal": "kaliémie normale"},
-    "Sodium": {"high": "hypernatrémie", "low": "hyponatrémie", "normal": "natrémie normale"},
     "Lipasémie": {"high": "pancréatite probable", "low": "normal", "normal": "pas de pancréatite"},
     "ASAT": {"high": "cytolyse hépatique", "low": "normal", "normal": "pas de cytolyse"},
     "ALAT": {"high": "cytolyse hépatique", "low": "normal", "normal": "pas de cytolyse"},
     "GGT": {"high": "cholestase/atteinte hépatique", "low": "normal", "normal": "pas de cholestase"},
+    "PAL": {"high": "cholestase/atteinte osseuse", "low": "normal", "normal": "pas de cholestase"},
     "Bilirubine totale": {"high": "ictère/cholestase", "low": "normal", "normal": "pas d'ictère"},
+    "Bilirubine directe": {"high": "cholestase/obstruction biliaire", "low": "normal", "normal": "pas de cholestase"},
+    "LDH": {"high": "cytolyse/hémolyse", "low": "normal", "normal": "pas de cytolyse"},
+    # --- Inflammatoire ---
+    "CRP": {"high": "infection/inflammation active", "low": "normal", "normal": "pas d'inflammation"},
+    "VS": {"high": "inflammation", "low": "normal", "normal": "pas d'inflammation"},
+    # --- Ionogramme ---
+    "Sodium": {"high": "hypernatrémie", "low": "hyponatrémie", "normal": "natrémie normale"},
+    "Potassium": {"high": "hyperkaliémie", "low": "hypokaliémie", "normal": "kaliémie normale"},
+    # --- Hématologie ---
+    "Hémoglobine": {"high": "polyglobulie", "low": "anémie", "normal": "pas d'anémie"},
+    "Plaquettes": {"high": "thrombocytose", "low": "thrombopénie", "normal": "numération normale"},
+    "Leucocytes": {"high": "hyperleucocytose", "low": "leucopénie", "normal": "numération normale"},
+    "TP": {"high": "normal", "low": "insuffisance hépatique/CIVD", "normal": "coagulation normale"},
+    "TCA": {"high": "hypocoagulabilité", "low": "normal", "normal": "coagulation normale"},
+    "Ferritine": {"high": "surcharge en fer/inflammation", "low": "carence en fer", "normal": "réserves en fer normales"},
+    # --- Rénal ---
+    "Créatinine": {"high": "insuffisance rénale", "low": "normal", "normal": "fonction rénale conservée"},
+    "Urée": {"high": "insuffisance rénale/catabolisme", "low": "normal", "normal": "fonction rénale conservée"},
+    # --- Cardiologie ---
+    "Troponine": {"high": "nécrose myocardique (SCA/IDM)", "low": "normal", "normal": "pas de souffrance myocardique"},
+    "BNP": {"high": "insuffisance cardiaque", "low": "normal", "normal": "pas d'insuffisance cardiaque"},
+    "NT-proBNP": {"high": "insuffisance cardiaque", "low": "normal", "normal": "pas d'insuffisance cardiaque"},
+    "D-dimères": {"high": "activation coagulation (EP/TVP possible)", "low": "normal", "normal": "EP/TVP peu probable"},
+    "INR": {"high": "hypocoagulabilité/surdosage AVK", "low": "hypercoagulabilité", "normal": "coagulation normale"},
+    "Fibrinogène": {"high": "inflammation/risque thrombotique", "low": "CIVD/insuffisance hépatique", "normal": "normal"},
+    # --- Infectiologie ---
+    "Procalcitonine": {"high": "infection bactérienne", "low": "normal", "normal": "pas d'infection bactérienne"},
+    "Lactate": {"high": "hypoperfusion/choc", "low": "normal", "normal": "pas d'hypoperfusion"},
+    # --- Métabolisme ---
+    "Glycémie": {"high": "hyperglycémie/diabète", "low": "hypoglycémie", "normal": "glycémie normale"},
+    "HbA1c": {"high": "diabète mal équilibré", "low": "normal", "normal": "équilibre glycémique correct"},
+    "Albumine": {"high": "déshydratation", "low": "dénutrition/insuffisance hépatique", "normal": "état nutritionnel conservé"},
+    "Acide urique": {"high": "hyperuricémie/goutte", "low": "normal", "normal": "uricémie normale"},
+    # --- Thyroïde ---
+    "TSH": {"high": "hypothyroïdie", "low": "hyperthyroïdie", "normal": "fonction thyroïdienne normale"},
 }
 
 
@@ -243,6 +273,7 @@ def _check_das_bio_coherence(dossier: DossierMedical) -> list[str]:
 
     # Patterns DAS → (test bio attendu, direction attendue)
     _DAS_BIO_CHECKS: dict[str, tuple[str, str]] = {
+        # Hématologie
         "leucocytose": ("Leucocytes", "high"),
         "leucopénie": ("Leucocytes", "low"),
         "leucopenie": ("Leucocytes", "low"),
@@ -254,8 +285,42 @@ def _check_das_bio_coherence(dossier: DossierMedical) -> list[str]:
         "anémie": ("Hémoglobine", "low"),
         "anemie": ("Hémoglobine", "low"),
         "polyglobulie": ("Hémoglobine", "high"),
+        "carence en fer": ("Ferritine", "low"),
+        "carence martiale": ("Ferritine", "low"),
+        # Ionogramme
         "hyperkaliémie": ("Potassium", "high"),
         "hypokaliémie": ("Potassium", "low"),
+        "hypernatrémie": ("Sodium", "high"),
+        "hyponatrémie": ("Sodium", "low"),
+        "hyponatremie": ("Sodium", "low"),
+        # Rénal
+        "insuffisance rénale": ("Créatinine", "high"),
+        "insuffisance renale": ("Créatinine", "high"),
+        # Digestif
+        "pancréatite": ("Lipasémie", "high"),
+        "pancreatite": ("Lipasémie", "high"),
+        # Infectiologie
+        "sepsis": ("CRP", "high"),
+        "choc septique": ("Lactate", "high"),
+        # Cardiologie
+        "infarctus": ("Troponine", "high"),
+        "syndrome coronarien": ("Troponine", "high"),
+        "embolie pulmonaire": ("D-dimères", "high"),
+        "insuffisance cardiaque": ("BNP", "high"),
+        # Métabolisme / nutrition
+        "dénutrition": ("Albumine", "low"),
+        "denutrition": ("Albumine", "low"),
+        "diabète": ("Glycémie", "high"),
+        "diabete": ("Glycémie", "high"),
+        "hyperuricémie": ("Acide urique", "high"),
+        "goutte": ("Acide urique", "high"),
+        # Thyroïde
+        "hypothyroïdie": ("TSH", "high"),
+        "hypothyroidie": ("TSH", "high"),
+        "hyperthyroïdie": ("TSH", "low"),
+        "hyperthyroidie": ("TSH", "low"),
+        # Coagulation
+        "civd": ("Fibrinogène", "low"),
     }
 
     # Indexer les valeurs bio disponibles

src/medical/bio_normals.py

@@ -6,20 +6,48 @@ from __future__ import annotations
 # Plages de référence biologiques (min, max) — utilisées par _is_abnormal()
 # et exportées pour le formatage du contexte LLM dans rag_search.py
 BIO_NORMALS: dict[str, tuple[float, float]] = {
+    # --- Hépatique / digestif ---
     "Lipasémie": (0, 60),
-    "CRP": (0, 5),
     "ASAT": (0, 40),
     "ALAT": (0, 40),
     "GGT": (0, 60),
     "PAL": (0, 150),
     "Bilirubine totale": (0, 17),
-    # Ionogramme (fallback adulte ; les règles de décision utilisent reference_ranges.yaml)
+    "Bilirubine directe": (0, 5),          # µmol/L
+    "LDH": (120, 250),                     # UI/L
+    # --- Inflammatoire ---
+    "CRP": (0, 5),
+    "VS": (0, 20),                         # mm/h
+    # --- Ionogramme (fallback adulte ; les règles de décision utilisent reference_ranges.yaml) ---
     "Sodium": (135, 145),
     "Potassium": (3.5, 5.0),
+    # --- Hématologie ---
     "Hémoglobine": (12, 17),
     "Plaquettes": (150, 400),
     "Leucocytes": (4, 10),
+    "TP": (70, 100),                       # %
+    "TCA": (25, 35),                       # secondes
+    "Ferritine": (20, 300),                # µg/L
+    # --- Rénal ---
     "Créatinine": (50, 120),
+    "Urée": (2.5, 7.5),                    # mmol/L
+    # --- Cardiologie ---
+    "Troponine": (0, 0.04),                # ng/mL (seuil hs-TnI)
+    "BNP": (0, 100),                       # pg/mL
+    "NT-proBNP": (0, 300),                 # pg/mL
+    "D-dimères": (0, 500),                 # ng/mL
+    "INR": (0.8, 1.2),                     # ratio
+    "Fibrinogène": (2, 4),                 # g/L
+    # --- Infectiologie ---
+    "Procalcitonine": (0, 0.5),            # ng/mL
+    "Lactate": (0.5, 2.0),                 # mmol/L
+    # --- Métabolisme ---
+    "Glycémie": (3.9, 5.5),               # mmol/L (à jeun)
+    "HbA1c": (4.0, 6.0),                  # %
+    "Albumine": (35, 50),                  # g/L
+    "Acide urique": (150, 420),            # µmol/L
+    # --- Thyroïde ---
+    "TSH": (0.4, 4.0),                    # mUI/L
 }
 
 

tests/test_bio_normals.py

@@ -0,0 +1,134 @@
+"""Tests unitaires pour les plages de référence biologiques."""
+
+import pytest
+
+from src.medical.bio_normals import BIO_NORMALS, _is_abnormal
+from src.control.cpam_context import _BIO_INTERPRETATION
+
+
+class TestBioNormalsCompleteness:
+    """Vérifie la complétude et la cohérence de BIO_NORMALS."""
+
+    def test_has_33_analytes(self):
+        assert len(BIO_NORMALS) == 33
+
+    def test_all_tuples_are_valid(self):
+        for name, (lo, hi) in BIO_NORMALS.items():
+            assert isinstance(lo, (int, float)), f"{name}: lo doit être numérique"
+            assert isinstance(hi, (int, float)), f"{name}: hi doit être numérique"
+            assert lo <= hi, f"{name}: lo ({lo}) > hi ({hi})"
+
+    def test_known_analytes_present(self):
+        expected = {
+            "CRP", "Hémoglobine", "Plaquettes", "Leucocytes", "Créatinine",
+            "Sodium", "Potassium", "ASAT", "ALAT", "GGT", "PAL",
+            "Bilirubine totale", "Lipasémie",
+            # Nouveaux Phase 5
+            "Troponine", "BNP", "NT-proBNP", "D-dimères", "INR", "Fibrinogène",
+            "Procalcitonine", "Lactate", "Glycémie", "HbA1c", "Albumine",
+            "Urée", "Acide urique", "TP", "TCA", "Ferritine", "LDH",
+            "Bilirubine directe", "TSH", "VS",
+        }
+        assert set(BIO_NORMALS.keys()) == expected
+
+
+class TestBioInterpretationConcordance:
+    """Vérifie que BIO_NORMALS et _BIO_INTERPRETATION sont synchronisés."""
+
+    def test_every_normal_has_interpretation(self):
+        missing = set(BIO_NORMALS) - set(_BIO_INTERPRETATION)
+        assert not missing, f"BIO_NORMALS sans interprétation: {missing}"
+
+    def test_every_interpretation_has_normal(self):
+        extra = set(_BIO_INTERPRETATION) - set(BIO_NORMALS)
+        assert not extra, f"Interprétation sans BIO_NORMALS: {extra}"
+
+    def test_all_interpretations_have_three_keys(self):
+        for name, interp in _BIO_INTERPRETATION.items():
+            assert "high" in interp, f"{name}: manque 'high'"
+            assert "low" in interp, f"{name}: manque 'low'"
+            assert "normal" in interp, f"{name}: manque 'normal'"
+
+
+class TestIsAbnormal:
+    """Tests pour _is_abnormal() sur les nouveaux et anciens analytes."""
+
+    def test_crp_high(self):
+        assert _is_abnormal("CRP", "180") is True
+
+    def test_crp_normal(self):
+        assert _is_abnormal("CRP", "3") is False
+
+    def test_hemoglobine_low(self):
+        assert _is_abnormal("Hémoglobine", "8.5") is True
+
+    def test_hemoglobine_normal(self):
+        assert _is_abnormal("Hémoglobine", "14.5") is False
+
+    # Nouveaux analytes
+    def test_troponine_high(self):
+        assert _is_abnormal("Troponine", "0.15") is True
+
+    def test_troponine_normal(self):
+        assert _is_abnormal("Troponine", "0.02") is False
+
+    def test_bnp_high(self):
+        assert _is_abnormal("BNP", "500") is True
+
+    def test_bnp_normal(self):
+        assert _is_abnormal("BNP", "50") is False
+
+    def test_lactate_high(self):
+        assert _is_abnormal("Lactate", "4.5") is True
+
+    def test_lactate_normal(self):
+        assert _is_abnormal("Lactate", "1.2") is False
+
+    def test_glycemie_high(self):
+        assert _is_abnormal("Glycémie", "8.0") is True
+
+    def test_glycemie_low(self):
+        assert _is_abnormal("Glycémie", "2.5") is True
+
+    def test_glycemie_normal(self):
+        assert _is_abnormal("Glycémie", "4.5") is False
+
+    def test_tsh_high(self):
+        assert _is_abnormal("TSH", "10.0") is True
+
+    def test_tsh_low(self):
+        assert _is_abnormal("TSH", "0.1") is True
+
+    def test_tsh_normal(self):
+        assert _is_abnormal("TSH", "2.5") is False
+
+    def test_inr_high(self):
+        assert _is_abnormal("INR", "3.5") is True
+
+    def test_inr_normal(self):
+        assert _is_abnormal("INR", "1.0") is False
+
+    def test_albumine_low(self):
+        assert _is_abnormal("Albumine", "20") is True
+
+    def test_albumine_normal(self):
+        assert _is_abnormal("Albumine", "42") is False
+
+    def test_ferritine_low(self):
+        assert _is_abnormal("Ferritine", "5") is True
+
+    def test_ferritine_normal(self):
+        assert _is_abnormal("Ferritine", "150") is False
+
+    # Valeurs textuelles
+    def test_text_negative(self):
+        assert _is_abnormal("CRP", "négative") is False
+
+    def test_text_positive(self):
+        assert _is_abnormal("CRP", "positive") is True
+
+    def test_unknown_test(self):
+        assert _is_abnormal("TestInconnu", "42") is None
+
+    def test_unparseable_value(self):
+        assert _is_abnormal("CRP", "non dosé") is None