1. به نام خدا

2. Case report

3. A 37 years old female patient (G2L1)was admitted in gynecology urgance with chief complaint of RLQ pain , nausia, vomitting, shoulder pain, rectal pressure that have been started a few hours ago and hystory of faint

4. Serum beta hcg titrage was >250 one days ago

5. VITAL SIGN
PR=125
BP=90/60
T=36.8(ORAL)

6. PHYSICAL EXAM PALE &ILL Obviouse tendernes & rebound tendernes in RLQ
Vaginal exam: no vaginal bleeding, cervical motion tendernes was positive in right

7. Patient immediately went to operation room for emergency surgery with diagnose of ruptured EP & in pre shock situasion with 2 units packed cell.

8. During the surgery patient received 1 packed cell.
Near the end of surgery patient have had hematuric bag with stable hemodynamic.
Immediately transfusion of packed cell stopped &pack cell with a sample of patiet blood have sent to the blood bank.

9. IN recovery vital sign of patient was:
PR=145
BP=70/50
TRANFUSION OF SERUM & MANITOL STARTED

10. MISMATCH TRANSFUSION OF ABO (A+ WAS INFUSED INSTEAD OF O+)
REPORT OF BLOOD BANK
MISMATCH TRANSFUSION OF ABO
(A+ WAS INFUSED INSTEAD OF O+)

11. The patient has transported to the ICU.
After 2 days ANORIC & RISENING OF CREATININ LEVEL was found as secondary findings (ATN)

12. LABORATORY FINDINGS
Hb=7.7 , 7.4 , 6.7 , 7 , 9.2 , 8 ,7.5 , 8.6 , 7.1 , 6.9 , 8.3
Plt=203 , 68 , 77 , 93 , 74 , 94 , 212 , 354 , 419 , 520 , 482
Serum bete hcG=3127
Cr=1 , 2 , 2.2 , 4.2 , 3.4 ,5 , 4.7 , 6.3 , 5.5 , 7.9 , 7.8 , 8.2 , 4.6 , 3.1 ,2.7 , 2.4 , 2 ,
LDH=2778
COOMBS(D:NEG , IND:NEG)

13. At least patient has needee 7 times HEMODIALYSIS to recovery.