"I have a mom who pumped 4 oz of bright red bloody milk (so much blood that it actually clotted after sitting for 10 minutes)"

Without being a medical person, I'd guess that the "clotting" is more likely coagulation from a Staph aureus mastitis, or from some trauma possibly including the pumping itself.  It doesn't take much blood to color a whole lot of liquid.  I can't picture having enough blood in a breastful of milk for it to clot despite the dilution, but milk from a traumatized or infected breast can form gelatinous blobs without any blood present at all.

I've seen a non-bloody coagulation effect clear completely from one pumping to the next, just by switching flanges, I've also seen "spontaneous" bleeding that never recurred, and it does seem that this mother's bleeding has slowed, so I'd be tempted to do nothing at all and see what happens over the next few days.  If the bleeding sort of sputters and subsides, I'd simply... let it go, without reporting it to an MD at all.

Again, this is a totally non-medical opinion, but we sometimes rupture a capillary in an eye and give ourselves a bright red - and totally meaningless - sclera for a while.  We may get a bloody nose because the air is dry.  We might bleed from a temporary rectal fissure.  Blood happens - from mild injury, or irritation, or from no source that we ever figure out.  I'd categorize spontaneous and rapidly self-limiting breast bleeding the same way I've heard both fainting and seizures categorized by the health care system itself: everyone is entitled to one unexplained faint or seizure.  Or one bloody breast? 

Maybe her toddler punched her.  Maybe she carried a bag of groceries with the tuna can digging in.  We tend to get really excited about breast anomalies, but surely healthy breasts are entitled to their own abrupt and transient glitches, just like other body parts? 

Probably anything she does - nursing, pumping, or allowing milk stasis - will trigger a little more bleeding, simply because there's already a ruptured blood vessel, so I wouldn't look for an immediate end to all bleeding.  I'd opt for continued nursing, knowing that the child may spit up some more blood (so don't put him in his dress whites for a while), and wait a bit.

Diane Wiessinger, MS, IBCLC, LLLL  Ithaca, NY  USA
www.normalfed.com  

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