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Pigment gallstone composition in patients with hemolysis or infection/stasis
Insights
Hemolysis contributes to pigment gallstone formation, particularly black stones in sickle cell disease patients. Biliary infection and stasis create distinct brown pigment stones, differing from those associated with hemolysis.
Area of Science:
- Biochemistry
- Gastroenterology
- Pathology
Background:
- Pigment gallstones are common, but their formation mechanisms, especially the roles of hemolysis and infection/stasis, require further elucidation.
- Sickle cell disease is associated with increased hemolysis, potentially impacting gallstone composition.
- Biliary tract infections and stasis are implicated in gallstone formation, particularly brown pigment stones.
Purpose of the Study:
- To investigate the influence of hemolysis and infection/stasis on the composition of pigment gallstones.
- To compare gallstone composition in patients with sickle cell disease (hemolysis) and Japanese patients with biliary infections (stasis/infection).
Main Methods:
- Gallstone composition was analyzed using infrared spectroscopy and chemical analyses.
- Comparison of stone composition across three patient groups: U.S. without hemolysis, U.S. with sickle cell disease, and Japanese with biliary infections.
Main Results:
- Gallstones from sickle cell disease patients showed higher pigment, carbonate, calcium, and measured components compared to controls.
- Black gallstones from both sickle cell and non-hemolysis groups shared similar calcium salt types, suggesting intermittent hemolysis as a formation mechanism.
- Japanese brown pigment stones lacked calcium carbonate, had low calcium phosphate, and contained calcium fatty acid salts, indicating stasis/infection involvement.
Conclusions:
- Intermittent hemolysis may contribute to the formation of black gallstones in the general population.
- Biliary stasis and infection lead to a distinct type of brown pigment gallstone, separate from hemolysis-associated stones.
- Cholesterol in these stones is likely due to coprecipitation, not supersaturation.
Abstract:
The effect of hemolysis and infection/stasis on pigment gallstones was assessed by comparing the composition of stones from (1) U.S. patients without hemolysis or cirrhosis, (2) U.S. patients with sickle cell disease, and (3) Japanese patients with biliary infections. Gallstone composition was quantitated by infrared spectroscopy and chemical analyses. Gallstones from patients with sickle cell anemia contained more pigment, carbonate, calcium, and measured components than stones from U.S. patients without hemolysis (P less than 0.05). However, the similar types of calcium salts in black stones from patients with and without sickle cell anemia suggested that intermittent hemolysis may be a potential mechanism in the formation of black stones found in the general population. In Japanese patients with brown pigment stones, there was an absence of calcium carbonate, low levels of calcium phosphate, and the presence of calcium salts of fatty acids (P less than 0.05). Thus, the accompanying stasis and/or infection in this latter group was associated with the formation of a distinctive stone type and was not involved in the formation of the black stones. The similarly small proportion of cholesterol in each of these groups suggested that it was present due to coprecipitation rather than to cholesterol supersaturation.