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Chronic Hemolysis and Pigment Gallstones: About 1% of bilirubin glucuronides are normally deconjugated in the biliary tree. In physiologic conditions, unconjugated bilirubin is a minor component of bile. In patients with pigment gallstones, there is an excess of unconjugated bilirubin in the bile. This is analogous to the supersaturation of bile with cholesterol in patients with cholesterol gallstones.
Chronic hemolysis is associated with increased secretion of conjugated bilirubin into bile, thereby allowing sufficiently large quanitities of deconjugated bilirubin to be formed, which eventually precipitates to form pigment stones.
Chronic hemolysis is associated with increased secretion of conjugated bilirubin into bile, thereby allowing sufficiently large quanitities of deconjugated bilirubin to be formed, which eventually precipitates to form pigment stones.