A arch children's hospital has apologised for 'failures' which led to the afterlife of a boyish leukaemia patient.
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Robyn Louise Ellson, 15, suffered a baneful acknowledgment to a affray of medication, an delving heard.
She was in absolution from the leukaemia, but her kidneys were declining because of the disease.
Doctors at Alder Hey Children's Hospital, Liverpool, did not realise that a aggregate of low-dose chemotherapy and branch dialysis would accept baleful consequences.
A arch children's hospital has apologised afterwards claret blight accommodating Robyn Louise Ellson, 15, suffered a baneful acknowledgment to a affray of medication and died
Robyn had been absolved but was re-admitted on January 11 2013 with bleeding gums, bark blisters, headaches and adenoids bleeds.
Her action deteriorated, claret clots formed in her airway, she suffered two cardiac arrests and she died in the aboriginal hours of January 19.
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At an delving at Liverpool Coroner's Court aftermost week, breadth coroner Anita Bhardwaj assured 'Robyn's affliction and analysis was poor'.
She criticised the hospital for a 'series of issues' which had contributed to Robyn's death, including 'a abortion to booty annual of (her) abiding renal condition' and 'a abortion to recognise a deterioration' in her condition.
Robyn, of, Flintshire, arctic Wales, had been diagnosed with blight in August 2012 and battled through backbreaking circuit of chemotherapy afterwards actuality transferred to Alder Hey from the Countess of Chester Hospital.
Dr Mark Caswell, a adviser haematologist at Alder Hey, declared Robyn's afterlife as 'a tragedy'.
He said: 'This was a huge shock to us all and a huge wake-up call. We are all devastated and we should accept advancing these problems.
'It was an abrupt reaction. So few accouchement ache from renal abortion that these were abrupt issues that we did not recognise. We are codicillary on guidelines but this was article that we aloof don't experience.'
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Robyn was in absolution from leukaemia, but her kidneys were declining because of the disease. Her analysis at Alder Hey Children's Hospital, Liverpool, was declared as 'poor'
The account of afterlife was accustomed as asphyxiation as a aftereffect of a respiratory amplitude haemorrhage, methotrexate (oral chemotherapy drug) toxicity, renal abortion and astute promyelocytic leukaemia (APL).
The leukaemia had acquired abiding renal abortion and as a aftereffect Robyn was put on 'maintenance therapy' which saw her accept low doses of methotrexate while on dialysis.
A affair captivated in December 2012 was declared as 'a absent opportunity' to altercate her action and the coroner apprenticed nurses to accumulate bigger addendum of analysis and meetings.
'Robyn's affliction and analysis was poor,' added Ms Bhardwaj who recorded a anecdotal adjudication afore alms her sympathies to the teenager's ancestors and friends.
A account from Robyn's addled parents, Garry and Debbie, said: 'Robyn was the best caring adolescent babe you could anytime ambition to accommodated and fabricated accompany calmly because anybody who met her admired her.
'She admired school, abnormally music and drama, and actuality in Babe Guides, Explorers and the Duke of Edinburgh scheme.
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Robyn's crestfallen parents Garry and Debbie said: 'Nothing will accompany Robyn back, but what's important to us now is that there is accountability and change to stop this accident again'
'She capital to assignment as a primary academy abecedary and had her accomplished activity planned out.
'As a ancestors we still attempt with the huge aperture her accident has larboard in our lives - the appulse runs added than anyone can imagine.'
The account continued: 'Basic training tells you to attending at someone's bloom annal to analysis whether medication is adapted and to anticipate they didn't do that is terrifying.
'Nothing will accompany Robyn back, but what's important to us now is that there is accountability and change to stop this accident again.'
Catherine Wardell, Alder Hey's accessory arch assistant for medicine, told the delving systems had been overhauled.
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A account from Alder Hey Children's NHS Foundation Assurance said the assurance 'accepted failures were made' during Robyn's treatment.
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