The presence of cholelithiasis was diagnosed by ultrasonography in 10 patients with thalassemia major aged 16 to 33 years. Other 10 patients aged 7 to 19 years showed acalculous cholecystopathy. Serum liver enzymes and ferritin levels, as well as splenectomy do not influence significantly the production of gallstones. Significant differences were observed in the age of patients with gallstones when compared to subjects without gallstones or with acalculous cholecystopathy. Although, in the last years, the high transfusional regimen has decreased the incidence of cholelithiasis, the frequent liver disease could be a cause of acalculous cholecystopathy in younger thalassemic patients.