Guided case: separate the evidence

The patient is admitted at 29 weeks 2 days with a singleton pregnancy and new hypertension. The two readings meet the ACOG hypertension threshold but are not severe range. The serum separator tube and lavender-top whole blood specimen are non-hemolyzed and are tested the same day. This supports interpreting the routine chemistry, hematology, and ratio results without a hemolysis interference flag.

The urine protein-to-creatinine ratio of 0.41 mg/mg meets the proteinuria threshold. Platelets are low at 118,000/µL but remain above the severe-feature cutoff. Creatinine is 0.9 mg/dL, below 1.1 mg/dL and not double the 0.6 mg/dL baseline. AST is 38 U/L with a local upper limit of normal of 32 U/L, so it is below twice that limit, and ALT is also below twice its local upper limit.

LDH and haptoglobin are within local reference intervals, and no schistocytes are reported on peripheral smear. The routine pattern therefore does not support active hemolysis or a laboratory severe feature at this draw. It does support preeclampsia by new hypertension plus proteinuria. The result needs continued clinical monitoring rather than a false reassurance from any one laboratory domain.

Elecsys sFlt-1 is 2,150 pg/mL and PlGF is 62 pg/mL, giving 2,150 divided by 62, or 34.7. In the PROGNOSIS validation population, a ratio at or below 38 supported a one-week rule-out claim for preeclampsia, eclampsia, or HELLP. It does not rule out preeclampsia already established by the clinical and proteinuria evidence. Release the verified panel with the calculated ratio and document routine referral and any local-policy notification required by the actual results.