I have always thought that blood expressed from the breast without nipple damamge is not a symptom with engorgement or mastitis.  However, I am reading in Breastfeeding, A Guide for the Medical Profession, Lawrence and Lawrence that, "Bloody discharge in pregnancy and lactation is most often caused by vascular engorgement or breast trauma."  Would someone be able to explain this to me?  I received a call from a mom who is breastfeeding and pumping for a one month old.  When she pumped this morning she noticed bright red blood from one breast and immediately stopped pumping.  She mentioned that this breast is tender especially around the areola and she has been feeling achy. She stated she has no nipple pain or nipple damage.  She has not had her pump turned up too high in her opinion. I was thinking intraductal papilloma as a possible cause and during my reading about this, I discovered the above quoted in this reference book. Looking to hear from others much more knowledgeable about this than I. 

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