Volume 16 - Clinical Quiz - Mastitis with Strawberry Coloured Breastmilk - Question and Answer

Aug 23, 2026

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Clinical quiz describing a 33-year-old lactating mother presenting with strawberry coloured/pink blood-stained breastmilk on the left breast for one day, accompanied by localized pain and mild swelling after returning to work and performing frequent double mechanical electric breast pumping. Initial assessment notes normal vital signs and no fever, lump, nipple cracks, or abnormal discharge; investigations including full blood count, milk analysis, and culture are normal. Questions address the most likely diagnosis and appropriate management, concluding with mastitis related to plugged ducts, trauma, and the need for prompt supportive care, effective milk removal, antibiotics, and analgesics.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Clinical Quiz

Case Presentation

Questions and Answers

Discussion

Volume 16 Number 1, June 2017 Clinical Quiz: The Strawberry Coloured Breastmilk Jamani NAa, Puteri Shanaz JKb aDepartment of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan Pahang bDepartment of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor HISTORY A 33 year-old Para 1 complained of strawberry coloured breastmilk for 1 day duration while expressing her breastmilk on the left breast at work. She has been exclusively breastfeeding for the past 6 months and never encountered such incident before. She also felt pain over the left breast. However, there was no lump, nipple crack,abnormal nipple discharges or fever prior to that. She expressed her breastmilk using a double mechanical electric breastpump about five times a day lasting from 10 to 20 mintues per sesion since she returned to work. On examination, her vital signs were normal and she was afebrile. Examination of the breasts revealed a lactating breast which were normal in size and shape. Her left breast showed a localized tenderness and was mildly swollen at the outer lower quadrant. No erythematous skin changes was noted. There was no palpable mass and no abnormal nipple discharges. A pink milk was seen when the nipple is expressed. The right breast and axillary region were normal.All investigations including full blood count, breast milk analysis, culture and sensitivity were normal. Figure 1. Blood stained breast milk Corresponding author: Nurjasmine Aida Jamani MD (UKM), M.Med (Fam Med) Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan Pahang [Email: minaida@iium.edu.my](Email: minaida@iium.edu.my) Question 1 What is the most likely diagnosis? A. Breast abcess B. Breast cancer C. Intraductal papilloma D. Mastitis E. Rusty pipe syndrome Answer: D Question 2 What is the most appropriate management for this patient? A. Advice to stop expressing her breastmilk B. Apply topical antibiotic C. Prescribe oral antibiotic D. Refer for mammogram E. Refer for ultrasound of the breast Answer: C DISCUSSION Blood stained breastmilk is not uncommon but can be alarming to a nursing mother. Blood in breast milk can vary in appearance from pink, orange, red and brown. Blood stained breast milk can be due condition like rusty pipe syndrome, nipple and breast trauma, as well as intraductal papiloma.1 This patient is diagnosed to have mastitis of the left breast which intially started as plugged ducts evidenced by focal breast engorgement which, after repeated pumping, had caused trauma to the blood capilaries of the breast giving the appearance of pink milk. Lactation mastitis is an inflammatory condition of the breast which may or may not be accompanied by infection. It is a clinical diagnosis and investigations are not indicated in the initial assessment.2 It can be caused by blocked milk ducts causing milk stasis which is a potential medium for bacteria growth. Mastitis is classically characterized by unilateral or bilateral breast pain or tenderness, swelling and segmentalerythema.2 A painful, white, 1-mm bleb may also be present on the nipple, which is thought to be an overgrowth of epithelium or an accumulation of particulate or fatty material.3 However, the signs and symptoms of infectious mastitis are difficult to distinguish from non-infectious mastitis.2 Mastitis Volume 16 Number 1, June 2017 can give rise to blood, mucus and pus in the milk. It must be treated promptly and adequately in order to prevent breast abcess and relapse. The main principle of treatment of mastitis is supportive counselling, effective milk removal, antibiotic therapy and adequate analgesics.2 Breastfeeding should be reinforced and is safe for the infant. REFERENCES 1. Mohrbacher N. Breastfeeding Answers Made Simple: A

FAQs

What is the most likely diagnosis for a lactating mother with strawberry coloured breastmilk?

Mastitis of the left breast, initially starting as plugged ducts and progressing with trauma to breast capillaries from repeated pumping.

Which management is most appropriate for this patient?

Prescribe oral antibiotics, along with supportive counselling and effective milk removal; breastfeeding should be reinforced as safe for the infant.

Why can blood appear in breast milk during lactation?

Blood-stained milk can vary in color and may result from conditions such as rusty pipe syndrome, nipple and breast trauma, or intraductal papilloma; in this case, milk removal caused trauma after focal engorgement from blocked ducts.

Aug 23, 2026

Uploaded by Paura