The Role of Ursodeoxycholic Acid in Treatment of Gallstones in Hemolytic Disorders

The research protocol extends for up to 12 months, during which the participant will attend 3 clinic visits at Shaare Zedek Medical Centre; one at study enrollment, one at 6 months and one at 12 months. All patients identified will have their medical records reviewed for previous clinical, biochemical or sonographic evidence of gallstones. Patients will undergo a baseline abdominal ultrasound to assess for biliary sludge, gallstones, or evidence of previous cholecystitis (eg. Thickened gallbladder wall). All patients will also have blood tested for liver biochemistry, complete blood count, hemolytic screen and fasting lipids. Participants will be commenced on UDCA 15mg/kg/day (maximum dose 900mg/day) in 2-3 divided doses for 12 months. Patients who are unable to tolerate tablet medication will be started on UDCA syrup at the same dose. Each of the in-house visits will include: 1. An explicit history taking and review of patient's notes, including review of symptoms, blood tests and previous ultrasounds, other medical conditions and medications. 2. Physical examination - including measuring splenic size, assessing for right upper quadrant abdominal tenderness 3. Blood tests 1. Hemoglobin, WBC 2. Liver biochemistry: ALT, AST, GGT, ALP (Alkaline Phosphatase), Bilirubin (conjugated and unconjugated), Albumin 3. Hemolytic screen: LDH, haptoglobin, reticulocytes 4. Fasting lipids: LDL, HDL, Triglycerides Repeat abdominal ultrasound will be performed at 12 months. The US will specifically relate to the following features in comparison to the baseline US: 1. Presence of biliary sludge 2. Presence of gallstone: i.Size ii.Number 3. Presence of bile duct dilatation 4. Presence of gall bladder wall thickening