ABSTRACT
Ruptured ectopic pregnancy is a form of obstetric hemorrhage which is the world leading cause of maternal mortality. A 22 year female admitted with chief complaint of abdominal pain and 2 months of amenorrhea and diagnosed as acute on chronic ruptured ectopic pregnancy. Emergency laparotomy was planned. Proper preanaesthetic check-up was done. There were no other comorbidities; no significant past and family history were present. Intra-operatively, fluid and PCV (patient's blood group was B-ve) replacement was done according to loss. Salphingoophorectomy was done and till then patient was vitally stable but just before closure, sudden hypotension, bradycardia, hemolysis were reported. After suspected blood transfusion reaction, PCV transfusion was stopped; iv line flushed with NS, Inj. Avil, Inj. Dexona and Inj. Hydrocort, Inj. Trenexa were given. Intra operative blood sample was collected and urgent ABGA, CBC, LFT, RFT, S. LDH were sent and patient was kept in OT for 1 hour after normal vitals and then shifted to ICU intubated. Monitoring core temperature, prompt use of measures to avoid hypothermia, using blood warmers, watch for hypocalcaemia, acidosis, and hyperkalemia go a long way in unmasking blood transfusion reactions. During operation, diagnosis becomes still more difficult and uncertain, because even when present, hypotension and oozing are easily attributed to events incident to anesthesia, operation or both. Thus hemolytic transfusion reactions occurring during operation are difficult to recognize early.