Because red blood cell hemolysis increases bilirubin production, the total serum bilirubin is increased in hemolytic diseases. This is accentuated in sickle cell disease because red blood cell sequestration in the liver and consequent hepatocellular dysfunction cause decreased bilirubin excretion. Because of the increase in bilirubin production, gallstones are common in SS disease. They are found in approximately 14 percent of children younger than age 10 years, about 30 percent of adolescents, and about 75 percent of adults by age 30 years.
Gallstones are frequently multiple.
They are composed mainly of desiccated bile, which is radiolucent, but the stones are radiopaque and contain calcium bilirubinate in about 60 percent of patients. Differential Diagnosis Gallstones can be totally asymptomatic for many years. Alternatively, they may cause chronic symptoms of fullness after meals, nausea, vomiting, and right upper quadrant pain. Complications of cholelithiasis include acute cholecystitis, common bile duct obstruction, and acute pancreatitis. Biliary colic may cause right upper quadrant or diffuse abdominal pain.