What should I do if I have a fever of hyperthermia after receiving an infusion?

Post-Infusion Fever at Home: Immediate Assessment and Management

Contact your healthcare provider immediately or go to the emergency department if you develop a fever of 101.3°F (38.5°C) five hours after receiving an infusion, as this may represent a delayed infusion reaction requiring urgent evaluation and potential treatment modification. 1

Understanding Your Fever

Your fever occurring 5 hours post-infusion falls into the category of a delayed infusion reaction, which can begin 1-14 days after infusion and typically consists of symptoms including fever, myalgia, arthralgia, headache, rash, and fatigue. 1 This is distinct from acute infusion reactions that occur during or within 24 hours of the infusion. 1

Immediate Actions You Should Take

Urgent Medical Contact

• Call your infusion center or prescribing physician immediately to report the fever, as delayed reactions require medical assessment to determine if the infusion can be safely continued in the future. 1
• Go to the emergency department if you develop any of the following warning signs:
  • Difficulty breathing or chest tightness 1
  • Severe rash or hives 1
  • Dizziness or feeling faint 1
  • Confusion or altered mental status 1

Symptom Monitoring

• Monitor your temperature every 2-4 hours and document the readings, as the height and duration of fever can indicate severity of the reaction. 2
• Watch for additional symptoms including muscle pain, joint pain, headache, rash, or extreme fatigue, which commonly accompany delayed infusion reactions. 1

What Your Healthcare Provider Will Assess

Severity Classification

Your provider will determine if this represents:

• A mild-to-moderate delayed reaction that can be managed with symptomatic treatment and premedication adjustments for future infusions 1
• A severe reaction (CTCAE grade 3 or higher) that may contraindicate future rechallenge with the same medication 1

Treatment Decisions

• For mild-to-moderate reactions, your provider may prescribe antipyretics (fever reducers), antihistamines, and/or corticosteroids for symptom control. 1
• For future infusions, if rechallenge is deemed safe, you will likely receive additional premedication with corticosteroids and antihistamines, along with a reduced infusion rate. 1
• Missing an infusion increases the risk of subsequent infusion reactions, so the next infusion should be administered more slowly with appropriate pretreatment. 1

Critical Pitfalls to Avoid

• Do not assume this is a simple viral illness without medical evaluation, as infusion reactions require documentation and may necessitate changes to your treatment protocol. 1
• Do not take the next scheduled infusion without discussing this fever with your healthcare team, as premedication adjustments may be necessary. 1
• Do not delay seeking care if symptoms worsen, particularly if you develop respiratory symptoms, severe rash, or hypotension, as these may indicate progression to a more severe reaction. 1

Documentation Requirements

Your healthcare provider should document this reaction including:

• Pre-infusion assessment details 1
• Grading of the reaction severity using standardized classifications like CTCAE 1
• Management interventions and response to treatment 1
• Plan for future infusions, including any modifications to premedication or infusion rate 1

Future Infusion Considerations

• Rechallenge is usually successful after delayed reactions when additional premedication (corticosteroids and antihistamines) is used and the infusion rate is reduced. 1
• Close observation for 24 hours after future infusions may be recommended depending on the severity of this reaction. 1
• Reactions with CTCAE grade 3 or higher severity should not be rechallenged with the same medication. 1