Patients undergoing stem cell transplantation (SCT) are at especially high risk of infusion-related reactions because:

  • They receive large volumes of cellular products or donor infusions.
  • They are already immunocompromised and at risk of infection, cytokine release, or allergic-type reactions.
  • Infusion reactions in this group can be harder to distinguish from other post-transplant complications such as infection, engraftment syndrome, or graft-versus-host disease.

Because of this, the algorithm builds in extra caution with premedication.

Acetaminophen Premedication

  • Standard recommendation: Give acetaminophen 1,000 mg PO for 1 dose before infusion.
  • Rationale:
    • Helps blunt fever and rigors that are common during cellular infusions.
    • Prevents masking of early febrile reactions, but balances comfort and safety.
  • In SCT patients: This step is emphasized even more strongly because fever may signal both HSR or infection/early sepsis. Nurses must still assess carefully whether fever resolves after intervention or persists (which may mean infection, not just reaction).

Antihistamine Premedication

  • Diphenhydramine is the cornerstone:
    • If no antihistamine was given within 30 minutes of the reaction, administer 50 mg IV push.
    • If diphenhydramine was already given within 30 minutes, repeat diphenhydramine 50 mg IV plus cetirizine 10 mg PO.
  • Why this matters for SCT:
    • Antihistamines reduce histamine-mediated urticaria, rash, and flushing, which are very common during donor product infusions.
    • Timing is critical — if given too early (more than 30 minutes before infusion), its protective effect wanes during the high-risk window.

Nursing Implications in SCT Patients

  1. Strict adherence to timing
    • Premedications (acetaminophen + diphenhydramine) should be given as close to infusion as possible, ideally within 30 minutes.
    • If symptoms occur despite premedication, re-dose according to algorithm guidance.
  2. Don’t overlook fever
    • Even with acetaminophen on board, monitor for persistent fever after intervention.
    • Distinguish between a drug/infusion reaction and a possible infectious cause, which in SCT patients can be life-threatening.
  3. Document premedication timing clearly
    • Note exact time acetaminophen and antihistamines were given relative to infusion start.
    • This information guides decisions if repeat dosing is required during a reaction.

✅ Bottom line:
For stem cell transplant patients, the algorithm emphasizes giving acetaminophen 1,000 mg PO and ensuring diphenhydramine timing is within 30 minutes of infusion to reduce reaction risk. Nurses should apply heightened vigilance, since fever or rigors in these patients can reflect both infusion reaction and serious infection.

Related Article

Infusion Reaction Management: MD Anderson Algorithm
How to Read and Apply the Infusion Hypersensitivity/Allergic Reaction Algorithm
PharKeep DigestKevin Van, PharmD, BCPS (Editor)