Pigmented gallstones are a common complication in which condition?

• A. Sickle cell disease
• B. Iron deficiency anemia
• C. Beta-thalassemia major
• D. Anemia of chronic disease

Answer: (C)

Pigmented gallstones arise when bilirubin from red blood cell breakdown accumulates in bile and precipitates as calcium bilirubinate. In chronic hemolytic conditions, there is a constant high turnover of heme, producing more unconjugated bilirubin that the liver cannot fully keep up with, so the excess bilirubin is excreted into bile and forms pigment stones. Beta-thalassemia major is a classic example of a severe, ongoing hemolytic anemia, making pigmented gallstones a common complication. Iron deficiency anemia and anemia of chronic disease involve little or no increased hemolysis, so they don't typically lead to pigment gallstones. Sickle cell disease also causes hemolysis and can produce pigment stones, but beta-thalassemia major is the most characteristically associated chronic hemolytic condition in this context.