Blood donations in Macedonia through times
In Republic of Macedonia, the roots of transfusion medicine date back to 1935 when the young doctor Pance Karagjozov, and later doctor Jovan Panovski introduced the so called direct transfusions. From a universal blood donor with Blood Type O ( in that time the Rh factor was not known), by means of Tsankov syringe, small portions of blood ( 20 ml) were directly transfused to the patient.
Formally, legal constitution of organized transfusion service was made on 1 July 1946 with the Act no. 1363 which stated: ” In order to ensure blood for the necessities of patients, the Ministry of Public Health in National Republic of Macedonia passes the following resolution in the Public hospital in Skopje, to form blood donating services. I assign d-r Branimir Simonovikj as a manager to the blood service center. This resolution comes in force on the day it is acknowledged – signed D-r Vukasin Popadikj ( then a Minister of Public Health)”. This set the foundations of transfusion services in the Republic of Macedonia.
After made preparations, on 13.07.1946, blood donating service started working. First employees together with d-r Branimir Simonovikj were nurses Branka, Magda, Penka and nurse Kosara. These five took the burden of the initial drawbacks in the work of the blood donating service. In this period first amounts of blood were collected and conserved.
This event was marked with а special featured article in the newspaper “Nova Makedonija” on 27 July 1946. In the period from 1946-1949, the scope of work of the unit was small and reached 206 liters of blood from 205 registered blood donors. These were mainly donors who received R1 cards for procurement of consumer goods. Taking and conserving of blood was in non-standard bottles, then the blood was filtrated through sterile gauze, and it was transfused to the patient through a unique rubber system sterilized before each use. In that period blood typing was made on a plate with 2 antiserums.
On 1 January 1949, after completion of the course for Managers at Transfusiology institutions in Belgrade, doctor Miko Karcovski was assigned a new manager and was preforming well in this role. 20 January, 1949 was the date when acting upon the suggestion of the new manager, the blood donating unit within the Public Hospital in Skopje, with the Resolution passed by the Ministry of Public Health on NRM was declared a STATE TRANSFUSION SERVICE working on newly given tasks- to provide blood, blood products and serums all health institutions in Macedonia, both civil and military.
In 1951 development of this service commenced throughout Macedonia, forming Transfusiology Cabinets in Bitola, Shtip and Prilep. The scope of work increased and in 1950 1.612 blood donations are registered, as in 1951 their number increased to 2.587.
In 1952 with the Resolution of NRM Government, The State Transfusion Service was declared to be a TRANSFUSION INSTITUTE OF NRM. Its first manager was doctor Miko Karcovski. This Institute contacted and later established a cooperation with National front, AFZH (Anti-Fascist Front of Women), Alliance of fighters, Youth Organization, Red Cross, Sanitary Service of YA, all with one cause; to conduct organizational and health education activities with the purpose to motivate the population to donate blood.
In 1953 the Red Cross of Yugoslavia was engaged in popularizing blood donation activities. In March 1953 first blood donating activities were organised following the newly established principles of VOLUNTARISM, ANONIMITY AND GRATUITOUSNESS. One of the organizers, apart from the Macedonian Red Cross and Macedonian Doctor Association was the Transfusion Institute. The same year, supported by the Belgrade Institute, first mobile teams started functioning and were directed to Titov Veles and Kumanovo. That year blood donations reached the number of 3.756.
In 1954 Transfusion Institute of NBRM formed its own mobile team that worked all over the country. Part of the collected blood was sent to Belgrade for the Yugoslav plasma program.
In 1955 the Institute was dislocated in the basement of today’s Surgical clinics in newly adjusted premises at its current location. The expansion of laboratory activities took place in new conditions: determination of Rh type was introduced, personal anticoagulant production for conservation of donated blood started, as well as preparation of infusion solutions and transfusion equipment. The number of employed people counted 22, among whom doctor Berisav Vujasin and doctor Nadezda Stojcevska- both full time doctors working hard on advancing transfusion services and integrating Transfusion within Clinical Medicine. The number of blood donations increased and reached 5.100. In 1958 first personal test serums were being increasingly prepared, also reagents for determining blood groups. Pregnant women were systematically tested at the Institute and in cooperation with the Gynecological Clinics first exsanguino transfusions were planned. This greatly contributed in decreasing neonatal mortality. Direct influence on the progress of the expert work had the joining of the new doctors to the team of the Institute: doctor Ljubica Sotirovska, doctor Vasil Zahariev and doctor Ivan Dejanov. Their zealous participation showed great effect in the progress of blood donatiing activities, where in the year of 1960 blood units rose to 15.447.
Premises became small to house the expanded activities of the Institute ( compatibility tests and coagulation examinations) which led to an additional building where 40 employees were employed, 5 of them- doctors. The Institute organisation was put to test when in 1963 the tragedy caused by the catastrophic earthquake hit Skopje. These were the moments when each and every employee showed their dedication. For the extraordinarily successful work in the period after the earthquake, the Institute was awarded the Order for Merits with silver rays. However, this catastrophe was also an invaluable lesson for better organisation in times of mass catastrophes, and better approach when responding to such mass disasters.
The importance of the Transfusion Service was noted in the highest circles in the country, especially the State Transfusion Institute. Therefore, in 1964 the procurement of, at the time, modern equipment for lyophilization, was assisted, so in 1965 plasma was successfully lyophilized as well as other blood products, which enabled the creation of the first blood reserves for emergency and war situations. In the following period of 20 years 1966-1986, the Institute and the transfusion activities in our Republic developed in yet greater speed. The first bone bank was formed and the cooperation with the Orthopedic Clinic became more profound. Autologous serum was prepared routinely, aimed for adjustment of cadaver cornea, for patients listed for corneal transplantation at the Clinics for ocular disorders. In 1968, the leading role in the State Transfusiology Institute was given to professor doctor Jonce Nedelkovski. The Institute consolidated both in personnel and finances. This development was especially stressed in the eighties when the new part of the building was finalised in the location of, at that time, the buildings of Transfusiology and Hematology Institute. Laboratories gain much more modern look purchasing highly sophisticated equipment. The efforts invested in development of specialized staff brought remarkable results.
Modern technological methods were introduced for blood cells separation, plasma fractioning and obtaining albumin, cryoprecipitate, fibrinogen, immune antiserums, plastic utensils for blood processing and its transfusion. Along with the improvement of production technology, laboratory work was also upgraded for introduction of immunological, immunochemical and immunogenic analyses. The Institute was working as a team and had cooperation with the Clinics within the Medical Faculty, especially with the Hematology Clinic due to their mutual ten-year long development.
Not only the development of the Transfusiology Institute was taking place but also the entire transfusiology services throughout Macedonia. Personnel and finance management as well as spatial planning, made these centers modern units where basic doctrines and methods were taught to others; such conditions provided modern and equal treatment for the citizens in all parts of Macedonia. Thanks to the Institute development, transfusiology exceeds the dimensions of a service, and rises to a level of equal, scientific and medical discipline without which sophisticated health care is not possible.
In 1974 the Congress for Transfusiologists and Hematologists from Yugoslavia was organized and held in Ohrid. In the eighties the Director of the State Transfusion Service is Primarius doctor Dragan Ivanovski. In this period the number of blood donors increased dramatically. Development based on the extremely professional work was supported by the state, especially by the Ministry of Health and Science.
With the Ministry of Defense intensive cooperation was established in the domain of stabile product preparation, first in the form of dry plasma, then 5% albumin. At the Department of serum and pheresis, doctor Bozidar Trajkovski mastered the production of hyperimmune serums from human origin, as well as serums from animal production and vegetable origin.
Prim. doc. Vladimir Milenkov introduced cell separation, therapeutic plasma and cytopheresis as a routine work. Doctor Risto Dukovski founded the laboratory for hemodynamic examinations and also introduced plethysmography and Doppler examination of blood vessels.
Prim. doc. Dragan Ivanovski was in charge of the Blood Products Section for longer period of time; he was awarded with the Order of Labour with silver wreath in 1979. Together with the ass. doc. Olga Damevska he introduced ionexchanging chromatography in the production of highly purified albumin. The number of blood units sent to further processing reached 90%. New quality was the establishment of the laboratory and later, the Section for histocompatibility and cell immunology by professor doctor Perko Kolevski. He was awarded Order of Merit for people with a silver star, for his expertise and hard work, in 1987. Professor Kolevski is the first minister of Health in the independant Republic of Macedonia ( 1991-1992).
Prim. doc. Milos Grubovikj worked continually on increasing the number of blood donors even in areas that were unsuccessful in the blood donating activities; he managed to achieve remarkable results, which brought him the Order of Labour with silver wreath.
Department of thrombosis, hemostasis and immunochemistry led by Prim. doc. Ivan Dejanov- awarded the Order of Labour with golden wreath in 1982- became a modern complex of laboratories where production of appropriate diagnostic reagents and hemostatic disorders therapy took place.
Immunohematology has a continual growth. This is the laboratory that welcomed the first PhD Thesis ” Alloimmunization to erythrocyte antigens”, a doctoral dissertation defended by doc. d-r Voskresija Stefanovska. Based on this long term project work the first erythrocyte panels were prepared and the same later were incorporated as a routine practice. For the development of the Pharmaceutical Section undoubted merits are addressed to M-r Petar Zafirovski. Section for staff issues as well as economic and financial matters was under the managmenet of the graduated economist Slobotka Nedelkovska. She has efficiently been working since the Institute foundation.
In the early eighties, Transfusiology became a major subject at the Faculty of Medicine. Senior University lecturer doctor Ivan Dejanov received special merits for the very beginning of this important benefit for the State Transfusiology Institute, as the first professor of Transfusiology. In the period that followed, professor Perko Kolevski and docents Voskresija Stefanovska and Stojanka Kostovska were assigned professors at the Faculty of Medicine. The teachers and the ten assistants conducted regular classes at the Department of Transfusiology and immunology within the Faculty of Medicine.
Association of Hematology and Transfusiology incorporated within the Macedonian Medical Association also performed certain actions regarding scientific and educational activities. Here the latest information was presented and exchanged in the area of hematology and transfusion medicine. In 1984 Yugoslav Hematological-transfusion days were successfully organised in Skopje. Apart from several defended doctoral dissertations, the number of PhD thesis published by the transfusiologists in the country and abroad was enormous. It cannot be precisely stated though, the same as the level of quality which was undoubtedly high. However, the fact is that Macedonian transfusiologists showed outstanding results, equal to those from other centers of former Yugoslavia, even broader.
For such progress and work, the State Transfusiology Institute was repeatedly honored as a collective. We mentioned the Order of Merit awarded after the earthquake in 1964. In 1986 due to 40 years of successful work after its foundation, the State Transfusiology Institute received an Order of Merit for the People with silver rays. One year later, as the best organization on the teritory of Republic of Macedonia, the Institute was awarded a plaque ” D-r Trifun Panovski”. Besides professional and educational thought, most heartening were the results in the field of blood donations.
After a long and gradual development followed with occasional stagnations, 50 year long efforts brought about great harvest. So, in 1989 the number of blood donations reached its record- 61.000, or 3,1% from the total population donated blood. Today, blood donating activities are based on a great cooperation among the Institute of Transfusion and Macedonian Red Cross as well as the Ministry of Health of RM. Their work proved especially valuable in 1994 where from 45.889, blood units in 1995 rose to 49.152. Primarily, the increase was due to the coordinated work of all the three parties stated above, as well as the formation of the Council of Transfusion within the Ministry of Health.
Major activities of the Council apart from satisfying the needs for blood and blood products, and efficient work of the Transfusiology service is also inroducing new ways for attracting mass population to donate blood and a new Law on Transfusion, as well as some supporting Acts which will regulate all activities related to transfusion medicine.
Today in Republic of Mаcedonia 320 employees are involved in transfusion activities, 147 employed in the Institute for Transfusion Medicine in Skopje. From 60 doctors all over the Republic, 54 are specialists tranfusiologists, 4 biologists, 2 specialists pharmacologists, one economist and one literature professor, more than 170 lab technicians…all these contribute to professional collection, control, processing, storing and distribution of blood and blood products.
Cooperation with transfusion centres from former Yugoslavia has been on a high level and still without interruptions till the present day. Great number of experts/professionals completed their trainings in Belgrade, Zagreb, Ljubljana, Athens, Sophia, as well as Budapest, Paris, Koln, Hamburg, Odessa, Copenhagn, Amsterdam, Moskow, Leningrad, Obninsk, Upsala, Oslow, Linkeping, Helsinki, Pitsburg, Chapelhill, Sydney, Melburn etc. However, the Council was also a place where many doctors and technicians from the country and abroad were educated. For example, after the formation of the Section for albumin preparation, experts from Brasilia and China were trained/educated to work on the problem of plasma fractionation with ionexchanging chromatography.
Within the gained international scientific-technical assistance 4 doctors and 9 lab technicians were residing and working in Dern, Musurata and Benghazi-Lybia, in the period from 1979 to 1987.
Looking retrospectively, the results of the Transfusiology Service are indisputable and represent a great support for further work: 1.228.760 blood units have been preserved, more than 1.100.000 plasma units have been prepared as well as 8.580 litres of serum and reagents for work in the Institute, more than 7.600.000 units of solution have been made and applied, more than 35.000.000 different laboratory procedures have been created.
These are only general numbers that speak about the work scope of State Institute and Transfusiology Service as a whole. This is the effort of more than 400 hardworking and humble employees that in the time span of 50 years have faced great number of problems from different nature, yet they have found a solution always in favor of the patient. We would like to list the name of those who are not among us any more: Branimir Simonovikj, Dragica Jovanovska, Ivan Kirovski, Trajko Anchevski, Pance Vucidolov, Jordan Atanasovski, Vebi Lija, Aleksandar Beldzigeroski. Transfusion service of RM, keeps pace with contemporary achievements and medical principals in general, using the standards and the recommendations of World Health Organization (WHO) and the Council of Europe for safe blood and blood product, as well as principles of transfusion medicine for rational usage of the same.
From January, 2011 pursuant to Law on Security in blood supply (September 2009), the Institute for Transfusiology and the remaining transfusiology services within the hospitals thoughout RM became an integrated service. The Statute of the Institute was changed; from a state institution it became the Institute for Transfusion medicine, where regional centres exist in Stip, Tetovo,and Bitola, also 18 services for transfusion medicine out of which 2 in Skopje and 16 in the other towns in the Republic.
Transfusion medicine in the following 100 years is seen as a major part in the chain that links laboratory and clinical medicine, the healthy and the sick. In the achievement of this aim, we had, we have and still expect further support from the Parliament of Republic of Macedonia, Ministry of Health, from the employees and activists from Macedonian Red Cross, from all health care workers, from the media, from the educational and scientific institutions and from all the citizens-blood donators in the Republic of Macedonia.
We warmly thank all.