A patient with thalassemia intermedia (beta-thalassemia with moderate hemoglobin) develops progressive splenomegaly, leg ulcers, and gallstones, but does not require regular transfusions. The gallstones in this patient are primarily composed of:

• A Pigment (bilirubin) stones due to chronic hemolysis generating excess unconjugated bilirubin ✓
• B Cholesterol stones due to increased cholesterol secretion
• C Calcium oxalate stones due to increased oxalate absorption
• D Mixed stones due to biliary stasis and bacterial colonization

Explanation

In chronic hemolytic anemias (including thalassemia, sickle cell disease, spherocytosis), excess RBC destruction releases heme, which is converted to unconjugated bilirubin. Elevated unconjugated bilirubin is conjugated by the liver, leading to supersaturation of bile with conjugated bilirubin. Spontaneous hydrolysis of conjugated bilirubin precipitates as calcium bilirubinate, forming black pigment gallstones. These stones are characteristically small, multiple, and radio-opaque.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.