Addison's disease is a rare endocrine disorder that frequently presents with non-specific symptoms, but may deteriorate rapidly into life-threatening Addisonian crisis if left untreated. Diagnosis can be difficult in patients without a suggestive medical history. We describe a case of a 37-year-old man who was admitted with acute kidney injury and hyperkalaemia, resistant to treatment with insulin/dextrose and calcium gluconate. On clinical examination, he was found to be hyperpigmented; a subsequent random serum cortisol of 49 nmol/L affirmed the preliminary diagnosis of Addison's disease. The patient's hyperkalaemia improved on treatment with hydrocortisone, and a follow-up morning adrenocorticotropic hormone of 1051 ng/L confirmed the diagnosis.

Introduction Deep vein thrombosis (DVT) in elective hip and knee arthroplasty range from 1-25%. The NICE Guidelines for Venous Thromboembolism (VTE) advise offering chemical prophylaxis with anti-embolism stockings (AES) as VTE prophylaxis. The aim of this study was to assess the role of anti-embolism stockings, by analysing the rates of DVT in patients who had chemical VTE prophylaxis in combination with anti-embolism stockings compared to patients who had chemical prophylaxis alone. Method Retrospective data analysis of patients who underwent elective primary hip or knee replacements from April 2018 to April 2019. Patient records were reviewed for each patient to identify any subsequent DVT diagnosis. Results 759 patients were identified. 595 patients had combined chemical VTE prophylaxis and AES. 164 patients did not have AES. 12 patients who received the combined therapy presented to A+E with suspected DVT, which was confirmed in two patients. Of the patients who did not receive AES, there were no cases of DVT. Conclusions There was no increase in DVT rates in patients who were not offered anti-embolic stockings. Taking into account the risks associated with AES and the costs incurred, the routine prescription of stockings must be carefully reviewed by orthopaedic departments.

The data sets analyzed during the current study is available from the corresponding author on reasonable request.

AIM: Orthopaedic procedures such as total hip and total knee replacements carry a significant risk of post-operative anaemia, necessitating allogenic blood transfusions (ABT), and an increased hospital length of stay. Our aim was to investigate whether the implementation of a local protocol designed to detect and treat pre-operative anaemia resulted in reduced ABT rates and a shorter duration of length of hospital stay (LOS). METHOD: We retrospectively audited 683 patients undergoing primary hip and knee replacements. We collated data for all patients about hospital length of stay and blood transfusions received. Both descriptive statistics and univariate analysis were performed. RESULTS: 21.6% of the cohort within the study who were anaemic at pre-operative clinic had a significantly increased median LOS of 2 days (P < 0.001), and an increased packed red cell transfusion rate compared to non-anaemic patients (26.1% vs 2.21%, P < 0.001). However, treatment of pre-operative anaemia did not show any significant difference in transfusion rates compared to patients who did not receive corrective treatment. The median LOS was higher by 1 day in the treated group compared to the non-treated cohort (P = 0.005). CONCLUSION: There is significant evidence to suggest that pre-operative anaemia can increase LOS and increase the risk of requiring post-operative blood transfusions. However, anaemia should be regarded as a characteristic that can add to the outcome in a cumulative manner, as opposed to an isolated factor. Further research is needed on how to better manage pre-operative anaemia in order to improve patients' outcomes.What's already known about this topic?• Pre-operative anaemia and allogenic blood transfusion lead to poor post operative outcomes • Pre-operative anaemia contributes to longer duration of hospital stay What does this article add?• This study has shown that there is no statistical difference between transfusion rates of anaemic patients optimised pre-operatively and anaemic patients who were inadvertently not. • Hospital length of stay is in fact longer in anaemic patients who received corrective treatment compared to the anaemic cohort group who did not.

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