Was paged during the night by a woman who had passed "a bit of flesh" in
her breastmilk when pumping her left breast, about the size of a ladybug
(ladybird beetle).  (When I asked if it was the size of a pencil eraser,
she said smaller, so I picked ladybug as the next common item to compare it
to in that size range.)

I asked if she thought it might be a blood clot, but she insists it is
fleshy. (This does not rule out the possibility of its being a blood clot.)
It is unlikely to be inspissated (thickened) milk, as the consistency of
flesh and blood clots is visibly more fibrous and structured.  She reports
that she has had "some" bleeding from that breast, apparently not a lot.

She had a temperature of 102.3 F three days previously, with a red area on
the left breast and no lump.  The doctor prescribed dicloxacillin over the
phone.  The fever subsided after initiation of antibiotic therapy.  The red
area did not change in size or color, but her milk supply dropped
precipitously bilaterally, and her 1 week-old baby's wet and soiled diaper
count dropped.  During the 24 hours preceding last night's call he had had
no soiled diapers and only 3-4 wet.

Following our call, she is initiating standard protocols for increasing
milk supply and managing mastitis.  This may be all that is required,
however:

My question concerns the material she passed in her breastmilk:  What
experience do you all have with this type of situation?  I had her
refrigerate the sample.  Although I want to be thorough in protecting my
patient, I am as yet unconvinced it warrants the expense and worry of a lab
work-up.  Her physician seems to respect my opinion and knowledge about
breastfeeding, and will be expecting a recommendation from me as to whether
to pursue further testing when I reach him.  Naturally, the ultimate
decision and responsibility will be his, but I want to be of some use in
providing accurate information.

Arly Helm, MS, IBCLC

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