# Rai 1975 CLL staging

Rai

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/rai`
HTML: https://magentlab.com/docs/rai
Markdown: https://magentlab.com/docs/rai.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply Rai 1975 original clinical staging of chronic lymphocytic leukemia and return rai_stage 0-4 from four caller-assigned flags.

## When to use

When an agent already has lymphadenopathy, hepatosplenomegaly, anemia (Hb <11 g/dL), and thrombocytopenia (platelets <100,000/mm3) assigned as in Rai 1975 for a patient recognized as CLL, and needs the published original stage. magent does not examine the patient or read a CBC.

## When not to use

- Not a medical device.
- Not a CLL diagnosis. Lymphocytosis is assumed; this tool is for a patient already recognized as having chronic lymphocytic leukemia.
- magent does not examine the patient or read a CBC. The caller assigns lymphadenopathy, hepatosplenomegaly, anemia_hb_lt_11, and thrombocytopenia_plt_lt_100 using the 1975 cutoffs (hemoglobin <11 g/dL; platelets <100,000/mm3).
- This tool is original Rai 1975 stages 0-IV only. It is not modified Rai (low / intermediate / high grouping).
- This tool is not Binet staging (Binet C uses hemoglobin <10 g/dL).

## Formula

```
rai_stage = 4 if thrombocytopenia_plt_lt_100; else 3 if anemia_hb_lt_11; else 2 if hepatosplenomegaly; else 1 if lymphadenopathy; else 0 (lymphocytosis only). Original Rai 1975 stages 0-IV. Not modified Rai. Not Binet.
```

## Citation

[Clinical staging of chronic lymphocytic leukemia](https://doi.org/10.1182/blood.v46.2.219.219)
Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS
Blood. 1975;46(2):219-234
DOI: [10.1182/blood.v46.2.219.219](https://doi.org/10.1182/blood.v46.2.219.219)

## Worked example

### Lymphocytosis only (all flags false)

Given: `anemia_hb_lt_11=false, hepatosplenomegaly=false, lymphadenopathy=false, thrombocytopenia_plt_lt_100=false`

1. thrombocytopenia_plt_lt_100 is false, anemia_hb_lt_11 is false, hepatosplenomegaly is false, lymphadenopathy is false
2. Highest applicable stage is 0 (lymphocytosis only)


## Also searched as

- Rai staging
- Rai classification
- Rai 1975
- CLL Rai stage
- chronic lymphocytic leukemia staging
- Rai stages 0-IV
- original Rai staging
- Rai CLL

## Parameters

- `lymphadenopathy` (boolean, required): Lymphadenopathy as assigned by the caller (Rai 1975 stage I when this is the highest finding). true or false. magent does not examine the patient.
- `hepatosplenomegaly` (boolean, required): Enlarged spleen or liver or both as assigned by the caller (Rai 1975 stage II). true or false. magent does not examine the patient.
- `anemia_hb_lt_11` (boolean, required): Anemia as assigned by the caller using the Rai 1975 cutoff hemoglobin <11 g/dL (hematocrit <33% is the same clinical call). true or false. magent does not read a CBC.
- `thrombocytopenia_plt_lt_100` (boolean, required): Thrombocytopenia as assigned by the caller using the Rai 1975 cutoff platelets <100,000/mm3 (<100×10^9/L). true or false. magent does not read a CBC.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/rai`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "anemia_hb_lt_11": "false",
      "hepatosplenomegaly": "false",
      "lymphadenopathy": "false",
      "thrombocytopenia_plt_lt_100": "false"
    },
    {
      "anemia_hb_lt_11": "false",
      "hepatosplenomegaly": "false",
      "lymphadenopathy": "false",
      "thrombocytopenia_plt_lt_100": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rai

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/rai",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS",
        "doi": "10.1182/blood.v46.2.219.219",
        "id": "rai-1975",
        "pmid": "1139039",
        "source": "Blood. 1975;46(2):219-234",
        "title": "Clinical staging of chronic lymphocytic leukemia"
      },
      "formula": "rai",
      "formula_expression": "rai_stage = 4 if thrombocytopenia_plt_lt_100; else 3 if anemia_hb_lt_11; else 2 if hepatosplenomegaly; else 1 if lymphadenopathy; else 0 (lymphocytosis only). Original Rai 1975 stages 0-IV. Not modified Rai. Not Binet.",
      "criteria": [
        {
          "factor": "thrombocytopenia_plt_lt_100",
          "met": false
        },
        {
          "factor": "anemia_hb_lt_11",
          "met": false
        },
        {
          "factor": "hepatosplenomegaly",
          "met": false
        },
        {
          "factor": "lymphadenopathy",
          "met": false
        }
      ],
      "thrombocytopenia_plt_lt_100": false,
      "anemia_hb_lt_11": false,
      "hepatosplenomegaly": false,
      "lymphadenopathy": false,
      "rai_stage": 0
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS",
        "doi": "10.1182/blood.v46.2.219.219",
        "id": "rai-1975",
        "pmid": "1139039",
        "source": "Blood. 1975;46(2):219-234",
        "title": "Clinical staging of chronic lymphocytic leukemia"
      },
      "formula": "rai",
      "formula_expression": "rai_stage = 4 if thrombocytopenia_plt_lt_100; else 3 if anemia_hb_lt_11; else 2 if hepatosplenomegaly; else 1 if lymphadenopathy; else 0 (lymphocytosis only). Original Rai 1975 stages 0-IV. Not modified Rai. Not Binet.",
      "criteria": [
        {
          "factor": "thrombocytopenia_plt_lt_100",
          "met": false
        },
        {
          "factor": "anemia_hb_lt_11",
          "met": false
        },
        {
          "factor": "hepatosplenomegaly",
          "met": false
        },
        {
          "factor": "lymphadenopathy",
          "met": false
        }
      ],
      "thrombocytopenia_plt_lt_100": false,
      "anemia_hb_lt_11": false,
      "hepatosplenomegaly": false,
      "lymphadenopathy": false,
      "rai_stage": 0
    }
  ]
}
```

## Response fields

- `formula` (string): rai
- `formula_expression` (string): Rai 1975 highest applicable stage: thrombocytopenia 4, else anemia 3, else hepatosplenomegaly 2, else lymphadenopathy 1, else 0
- `rai_stage` (integer): Original Rai 1975 stage 0, 1, 2, 3, or 4. Not modified Rai. Not Binet.
- `lymphadenopathy` (boolean): Echo of the caller-assigned lymphadenopathy flag
- `hepatosplenomegaly` (boolean): Echo of the caller-assigned spleen-or-liver enlargement flag
- `anemia_hb_lt_11` (boolean): Echo of the caller-assigned anemia flag (Rai 1975 Hb <11 g/dL)
- `thrombocytopenia_plt_lt_100` (boolean): Echo of the caller-assigned thrombocytopenia flag (platelets <100,000/mm3)
- `criteria` (array): Per-factor rows with factor and met in tree order: thrombocytopenia, anemia, hepatosplenomegaly, lymphadenopathy
- `citation` (object): Rai 1975 Blood citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS",
    "doi": "10.1182/blood.v46.2.219.219",
    "id": "rai-1975",
    "pmid": "1139039",
    "source": "Blood. 1975;46(2):219-234",
    "title": "Clinical staging of chronic lymphocytic leukemia"
  },
  "formula": "rai",
  "formula_expression": "rai_stage = 4 if thrombocytopenia_plt_lt_100; else 3 if anemia_hb_lt_11; else 2 if hepatosplenomegaly; else 1 if lymphadenopathy; else 0 (lymphocytosis only). Original Rai 1975 stages 0-IV. Not modified Rai. Not Binet.",
  "criteria": [
    {
      "factor": "thrombocytopenia_plt_lt_100",
      "met": false
    },
    {
      "factor": "anemia_hb_lt_11",
      "met": false
    },
    {
      "factor": "hepatosplenomegaly",
      "met": false
    },
    {
      "factor": "lymphadenopathy",
      "met": false
    }
  ],
  "thrombocytopenia_plt_lt_100": false,
  "anemia_hb_lt_11": false,
  "hepatosplenomegaly": false,
  "lymphadenopathy": false,
  "rai_stage": 0
}
```

## Errors

- HTTP 400 `invalid_rai`: each Rai 1975 staging flag must be true or false. Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [CLL-IPI](https://magentlab.com/docs/cll-ipi) — Sum the 2016 CLL-IPI (chronic lymphocytic leukaemia international prognostic index) and return low (0–1), intermediate (2–3), high (4–6), or very_high (7–10).
- [Binet](https://magentlab.com/docs/binet) — Apply Binet 1981 chronic lymphocytic leukemia staging and return stage A, B, or C from caller-assigned anemia (Hb <10 g/dL), thrombocytopenia (platelets <100×10^9/L), and involved lymphoid areas (0-5).

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.