Global Journal of Transfusion Medicine

REVIEW ARTICLE
Year
: 2020  |  Volume : 5  |  Issue : 2  |  Page : 126--128

Analysis of the transfusion situation in Albania


Irena Seferi, Mirela Spahiu, Viola Shano 
 National Blood Transfusion, Tirana, Albania

Correspondence Address:
Irena Seferi
National Blood Transfusion, Tirana
Albania

Abstract

The National Blood Transfusion Center in Albania was established in 1951. The establishment of the NBTC was followed by the creation of 26 blood banks near each hospital to provide patient services at every hospital. The National Blood Transfusion Center (NBTC) has developed a legal and regulatory framework beginning with the first law on blood transfusion approved in 1995. Blood donation in Albania began as a remunerated practice. The first attempts at voluntary and nonremunerated blood donation (VNRBD) began in 1994 with cooperation between NBTC and the Albanian Red Cross, but without a clear definition of a promotional strategy. In 2004, the NBTC realized the need for voluntary nonremunerated blood donors, and with the technical assistance of the WHO, NBTC drafted the National Strategy for a Safe Blood Transfusion. The strategy laid the foundation for standardization of two of the main blood safety factors; qualitative donors and qualitative testing. The implementation of this strategy and the law marked continued success in the work of NBTC by recording increase in VNRBD and reduction in remunerated blood donations. Centralized testing of infectious agents was started in NBTC Tirana, with the implementation of fully automated testing. A new strategy will be launched this year aiming for 100% voluntary nonremunerated blood donors.



How to cite this article:
Seferi I, Spahiu M, Shano V. Analysis of the transfusion situation in Albania.Glob J Transfus Med 2020;5:126-128


How to cite this URL:
Seferi I, Spahiu M, Shano V. Analysis of the transfusion situation in Albania. Glob J Transfus Med [serial online] 2020 [cited 2021 Apr 13 ];5:126-128
Available from: https://www.gjtmonline.com/text.asp?2020/5/2/126/300626


Full Text



 Introduction



The National Blood Transfusion Center (NBTC) was established in 1951 followed by the creation of a network of blood banks to provide patient services at every hospital and simultaneously create the provision for blood donation in any hospital.[1] Thus, in a short time, 26 blood banks were created, one in each district, accompanied by the opening of 5 other blood banks in Tirana after the 1990s, taking the total number of blood banks to 31.

Throughout these years, NBTC has exercised a controlling, inspecting, and educational function for the entire transfusion service at the national level.

Regarding the legislation in transfusion, we can say that the first law on transfusion was approved in 1995, and together with it, some regulatory bylaws, mainly related to the regulation of activity blood bank clinic and selection of blood donors was introduced. The limitations of this law were that it did not reflect the principle of voluntary nonremunerated blood donation (VNRBD) and did not include the concepts of hemovigilance and traceability. In 2007, a new law 9739 dated May 21, 2007 for the Republic of Albania was approved. This law was based on directive 2002/98/EC, and for the first time recognized the human values of solidarity, expressed through voluntary, nonremunerated, regular, responsible, anonymous blood donation, a concept that emphasized precisely the main standard of blood quality and safety of blood components. Implementation of this law by the Council of Ministers brought in cooperation between state and various associations in promoting VNRBD.

Blood donation in our country began as a remunerated practice and continued as such for 50 years creating a tradition, difficult to eradicate. Immediately after its establishment in 1952, the NBTC began its efforts to recruit voluntary blood donors in cooperation with the Red Cross.[2] But that did not last so long, and a decision of Council of Ministers defined “Some favorable conditions for blood donors” which consisted of coupons for free meals and cash compensation equal to 1 month's salary of a worker. This decision marked the introduction of the wrong path of paid blood donation, a path that predominated until early 2000. This practice attracted many donors leading to sufficient blood and components for that time. This practice persisted until the early 1990s, when for the first time NBTC recognized nonremunerated donations, as a way to achieve adequate blood supply.

The first attempt at VNRBD began in 1994 with cooperation between NBTC and the Albanian Red Cross, but without a clear definition of a promotional strategy. The economic and political crisis of 1997, as well as the Kosovo crisis, completely diverted the energies and attention of the Red Cross, resulting in the slowdown of the VNRBD movement. This had a negative impact on voluntary blood donation in the country. Likewise, the Albanian society in the 1990s faced sharp political, social, and economic problems, and when a society is facing with such problems, it is quite difficult to accept and even more to adopt and uproot the principles of altruism and solidarity. In this situation, nonremunerated donations remained negligible and remunerated ones continued to attract more and more donors from low socioeconomic backgrounds influencing directly on blood safety.

In 2004, the NBTC decided that the need for voluntary nonremunerated blood donors had already become an emergency, and with the technical assistance of the WHO, NBTC drafted the National Strategy for Safe Blood Transfusion.[3] The strategy laid the foundations for the standardization of two of the main blood safety parameters:

  1. Qualitative donors (improvement in quality of donors), through the promotion of VNRBD in cooperation with associations such as the Red Cross and the association of voluntary blood donors
  2. Qualitative testing (improvement in quality of testing) through centralization of testing in one testing center. It is important to mention here that in those times (before 2004), blood was tested with rapid tests in each blood bank where it was collected.


The main components of this strategy were subsequently approved in the Transfusion Law 9739 dated May 21, 2007 for the Republic of Albania, in its bylaws.

The implementation of this strategy and the law marked continuous success in the work of NBTC leading to increased VNRBDs and reduction of remunerated blood donation. The centralization of testing for infectious agents, only in NBTC Tirana, was implemented using fully automated testing for infectious agents.

All these achievements of the NBTC were also recognized by the WHO which has mentioned Albania as “success story” for achievements in the field of blood transfusion.

NBTC is financed from the state budget and through its annual budget covers salaries for NBTC headquarters and blood banks, investments for NBTC headquarters and blood banks in Tirana, and consumables for all transfusion centers at the national level. Investments in infrastructure and equipment in blood banks in the districts remain the responsibility of the hospital directorate, while all consumables are provided by the NBTC headquarters.

 Transfusion in Albania, Actual Facts, and Figures



The population of Albania is 2,862,427 and the total number of donations for the year 2019 was 33,602.

The donation rate amounts to 11.8 donations/1000 inhabitants.

 Structure of Blood Transfusion Service



There are two blood establishments as per the definition in the directive 2002/98/EC and these are NBTC Tirana and the Blood Bank of Lushnja. NBTC Tirana has centralized processing of blood; the six hospital blood banks in the Tirana region send their donations to NBTC Tirana for processing. The Blood Bank of Lushnja processes all its donations but lacks centralization.

All other transfusion centers (25 at the national level) are hospital-based blood banks, but they collect blood because we are insufficient and most of our blood supply still comes from family replacement donors; therefore, all hospital blood banks collect blood from family replacement donors. These hospital-based blood banks do not process blood; they separate by sedimentation because of lack of capacities.

The blood donation figures over years are shown in [Table 1] and [Figure 1], [Figure 2], [Figure 3]:{Table 1}{Figure 1}{Figure 2}{Figure 3}

 Testing for Transfusion Transmissible Infections



Testing for infectious agents is fully centralized, and blood collected at the national level is tested at NBTC Tirana with fully automated methods by serology (traditionally) and nucleic acid amplification technique since 2016.

Infectious markers in our donor population, 2019 data, are as shown in [Table 2]:{Table 2}

The high prevalence of infectious markers in our donor population compared to our region is mostly dedicated to the fact that most of our donations come from first-time family replacement donors (73%). A study conducted in 2015 in the donor population of Tirana[4] revealed a statistically higher prevalence of HBV, HIV, and syphilis in first-time family replacement donations compared to first-time voluntary nonremunerated donations.

Immunohematology testing is centralized at NBTC Tirana only for blood banks of the Tirana region, whereas all other blood banks perform immunohematological testing of collected blood by themselves.

There are no plasma collection centers, apheresis centers, or fractionation plants in our country.

 Future Development



According to a World Health Organization index, a country is sufficient in blood/components when 1%–3% of the population donates blood. The lower the development of medicine, the lower the sufficiency threshold (1% is enough) and higher this development, higher the self-sufficiency threshold (3% of the population needs to donate blood). The current level of development of the health sector in our country with the introduction of challenging therapeutic regimes and needs 1%–2% of the population, to donate. This requires necessary interventions to reach 2% of donations for sufficiency. All necessary interventions to achieve this goal are part of our new “National Strategy for Safe Blood Transfusion” that will be launched this year with the main objectives of:

  1. 100% VNRBD through reorganization of promotion and retention of voluntary nonremunerated donation based on the WHO strategy[5]
  2. Reorganization of services with 5 regional blood establishments and 25 hospital blood banks
  3. Organization of hemovigilance network at the national level.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Qendro Seferi I. Blood donation in Albania. ESTM residential course proceedings, transfusion safety: From donor to patient. Tirana 2009:15-8.
2Qendro-Seferi I, Pipero P. Voluntary non-remunerated blood donation in Albania: Past, present, future. ESTM residential course proceedings, transfusion medicine: Development in Albania and in Europe. Tirana 2011:19-22.
3National Strategy for Safe Blood Transfusion 2005-2010. Available from: https://shendetesia.gov.al/wp-content/uploads/2018/08/1.pdf. [Last accessed on 2020 Oct 12].
4Seferi I, Abazaj ZH, Metka A. Infectious agents in blood donor population in Tirana. Vox Sangunis. Special Issue: Abstracts of the 25th Regional Congress of the International Society of Blood Transfusion in conjunction with the 33rd Annual Conference of the British Blood Transfusion Society, London, UK; 2015. p. 124.
5WHO 2010. Towards 100% Voluntary Blood Donation. Global Framework for Action. Available from: https://www.who.int/bloodsafety/publications/9789241599696/en/. [Last accessed on 2020 Oct 12].