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I have a 36 y/o G2P2 about 5 weeks postpartum. She noticed significant bright
red blood during lactation when her infant vomited the blood and she noticed
it was coming from her breasts. It is bilateral, multiple ducts, it has
happened several times when she pumps and once spontaneously to a significant
degree. There is a greater degree of discomfort with the bleeding more so than the
discomfort of engorged breasts. I couldn't get a quantitative answer but it is
enough to almost fill a baby bottle. She has no obvious masses except for the
normal engorged breasts. The is no sign of infection and the external nipple
complex is not the source. I have never heard of this, nor can I find much
about it in the literature (except for the usual bloody discharge that doesn't
seem as significant as this). Does anyone have any experience with this?



deployed - 02:31pm May 3, 2004     (#1 of 2) Add to 'My Discussions' | Post
to this topic

Per Dr. Ruth Lawrence (Breastfeeding: A guide for the medical profession) pg.
542. " The Lactation Study Center frequently recieves calls regarding pink
(guaiac positive) or frankly bloody milk .. It is painless and may go unnoticed
unless the mother is pumping her milk or her infant vomits blood that is
positive for adult hemoglobin (Apt test), eliminating cases of bleeding of the
newborn gastrointestinal tract, which is positive for fetal blood by Apt test. If
the infant tolerates the milk, breastfeeding can continue and the blood
usually disappears in 3 to 7 days. the explanation of this penomena is probably the
increased vascularization of the breast coupled with rapid development of the
alveoli. If the blood persists or is recurrent , the breast should be
evaluated by mammography." I will also query the Listserve for The Academy of
Breastfeeding Medicine to see if they have any other words of wisdom.



An_1218646 - 05:15pm May 28, 2004     (#2 of 2) Add to 'My Discussions' |
Post to this topic

Dr. Lawrence has outlined the most likely etiology of a bloody nipple
discharge in this person; rapid proliferation and increased vascularization. We see
this in non-pregnant teenagers that have rapid breast development as well.
Mammography is a reasonable option if it persists, however, the density of the
breast is increased during lactation making subtle lesions difficult to see.
Another option is specific duct DUCTAL LAVAGE with cytology. This technique
canulizes the specific duct with the bloody discharge capturing cells in the
discharge for cytological review, keeping in mind that the early lactating breast
will show a lot of proliferation. Another option is galactography (ductogram),
again canulizing the specific duct that has the bloody discharge. An intraductal
pappilloma (B-9) is a common cause, however, I have seen extensive DCIS as a
cause of persistant boody nipple discharge. Of course, persistance of the
bloody nipple discharge is not safe to ignore.





Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
Maternal-Child Adjunct Faculty Union Institute and University
Film Reviews Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative

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