Gallstones

Gallstones are common in thalassaemia, and the reason is straightforward. Red cells break down faster than usual, and that process makes bilirubin — the pigment that also causes the mild yellowing some people notice in their eyes. Excess bilirubin can settle into stones in the gallbladder.

This is why gallstones can appear young in thalassaemia, sometimes in the teens, rather than in middle age as they usually do otherwise.

Who gets them more often

Anyone with more red-cell breakdown is at higher risk, so it is more common in people who are not transfused regularly and in people whose spleen is working hard. Some people also carry a completely separate, harmless gene variant called Gilbert syndrome, which raises bilirubin on its own — and having both makes stones more likely still.

None of that is caused by anything you did or did not do.

What they feel like

Many gallstones cause nothing at all and are found by chance on an ultrasound. When they do cause trouble, it is usually:

• pain in the upper right of your abdomen, often after a fatty meal, that can build over an hour or two and reach round to your back or shoulder
• nausea or vomiting with it
• deeper yellowing of the eyes or skin than your usual, or pale stools and dark urine

Pain with fever, or with yellowing that is new or worsening, needs to be seen the same day rather than waited out — a stone can block the bile duct or the gallbladder can become infected.

What is done about them

Stones causing no symptoms are often simply left and watched. Stones causing repeated pain are usually treated by removing the gallbladder, which is a routine keyhole operation and does not change what you can eat afterwards for most people.

If you are having your spleen removed for other reasons, your surgeon may suggest taking the gallbladder at the same time if stones are present, to save a second operation.

Worth knowing rather than worrying about: it is common, it is explainable, and it is fixable.