ABSTRACT
Hemophilia is mostly an inherited genetic disorder, caused by mutations in the clotting factor gene. With the available treatment options, life expectancy of a hemophilic patient is usually of that of the general population. Hence, it is not uncommon that they present for surgical procedures. However, hemophilic patients for the major surgical procedure are always a real challenge for the perioperative physician. We have recently encountered one such patient who was hospitalized with acute paraplegia due to a mass lesion of spine and successfully managed with the recovery of motor power. His pre-operative Factor VIII level was 0. Desmopressin nasal spray has a limited role in severe hemophilic. Our main concern was effective replacement therapy and maintenance of desired Factor VIII levels not only during surgery but also in the immediate post-operative period