What gallbladder pathology is classic in patients with hemolytic anemias?

In patients with hemolytic anemias, the classic gallbladder pathology that develops is bilirubin gallstones. This is primarily due to the excessive breakdown of red blood cells, which leads to an increase in bilirubin levels in the bloodstream. When there is an overload of bilirubin, particularly unconjugated bilirubin, it can precipitate and form stones within the gallbladder.

The formation of bilirubin gallstones is directly linked to the pathophysiology of hemolytic anemias, where the rapid destruction of erythrocytes results in more bilirubin being produced than the liver can conjugate and excrete. This excess bilirubin then enters the bile and can crystallize, leading to the development of stones made predominantly of bilirubin pigment.

Other types of gallstones exist, such as cholesterol stones, which typically form when there is an imbalance in the cholesterol and bile salts, and mixed stones, which contain both cholesterol and bilirubin. However, in the specific context of hemolytic anemias, bilirubin stones are the hallmark finding, as the increased bilirubin from hemolysis plays a central role in their formation.