Here are some ideas, not necessarily in any order:
 
1. Foremilk - hindmilk imbalance with gut irritation when baby directly breastfeeds. Not seen when mom pumps it out and feeds in bottle. This would usually present as lower gut bleeding, but who knows.
2. Nipple trauma or internal problem on one breast - try bf on other side and see if blood disappears. Express the affected side and do not feed to baby yet. Just freeze it. If baby does not spit blood when nursing on unaffected side (the one without the crack) then it could indicate it is not a baby sucking problem - but it could be that one-sided bf is  helping to  resolve any foremilk hindmilk issues too.
3. Baby sucking problem leading to trauma. Tongue-tie or clenching/clamping type of suck or something like that. If this is the case, it should occur on both breasts. You could try it by just nursing on one side, as above.
4. You  could also test to make sure it is mother blood and not baby blood.
 
Laurie Wheeler, IBCLC, MN, RN Mississippi, s.e. USA 
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