INTRODUCTION Haemophiliacs undergo surgery for intracranial bleeds, hemarthrosis, dental problems and are at risk of life threatening haemorrhages during surgery. So perioperative management in severe hemophiliacs is a challenging task.

CASE REPORT In our case, a 8 months old male baby weighing 8 kg was diagnosed with severeHaemophilia-A. CT Brain was s/o acute large SDH noted along entire left cerebral convexity with ongoing bleeding and Sub-falcine herniation and 1.4 cm shift towards right with mass effect. After pre-anaesthesia evaluation and informed high risk consent, patient was posted in emergency for SDH evacuation.

This was an intricate case which needed pre-optimisation and hence a strategy was planned to achieve the objective with minimal risk. General Anaesthesia with neuro-anaesthesia protocol was given and left FTP craniotomy and decompression of SDH was done. Course was uneventful.

RESULTS : General Anaesthesia with neuro-anaesthesia protocol. Uneventful course.

CONCLUSIONS : In such cases, to improve the outcome of these patients early intervention, careful management and normalization of haemostatic defects with aggressive factor replacement therapy are required along with adequate preoperative work-up and blood bank support.