Blood Elemental
Medium • Elemental • Neutral
Armor Class 15
Hit Points 120 (16d8 + 48)
Speed 30 ft., swim 60 ft.
Initiative +3 (13)
| STR | DEX | CON | INT | WIS | CHA |
|---|---|---|---|---|---|
| 14 (+2) | 16 (+3) | 16 (+3) | 8 (-1) | 14 (+2) | 10 (+0) |
Skills Perception +5
Damage Resistances acid, fire
Condition Immunities exhaustion, grappled, paralyzed, petrified, prone, restrained, unconscious
Senses darkvision 60 ft., passive Perception 15
Languages Primordial (Aquan)
CR 8 (XP 3,900; PB +3)
Blood Form. The elemental can enter an enemy's space and stop there. It can move through a space as narrow as 1 inch without expending extra movement to do so.
Blood Sense. The elemental knows the location of any creature within 100 feet that doesn’t have all its hit points. It can’t detect Constructs, Elementals, Oozes, or Undead this way.
Hemorrhagic Aura. Creatures of the elemental’s choice that don’t have all their hit points and are within a 10-foot emanation originating from the elemental lose 5 hit points due to blood loss at the start of their turn. The elemental then regains that amount of hit points. Constructs, Elementals, Oozes, and Undead are immune to this effect.
Unusual Nature. The elemental doesn't require air, food, drink, or sleep.
ACTIONS
Multiattack. The elemental makes two Sanguine Slash attacks. It can replace one of these attacks with a Blood Infusion.
Sanguine Slash. Melee Weapon Attack: +6, reach 5 feet. Hit: 25 (5d8 + 3) slashing damage.
Blood Infusion. The elemental targets a creature within 5 feet, and the target regains 21 (5d8) hit points. Then the elemental loses an equal amount of hit points. This ability can’t target Constructs, Elementals (except other blood elementals), Oozes, or Undead.
Drain. Constitution Saving Throw: DC 14, one creature that the elemental can see and that doesn’t have all its hit points within 30 feet. Failure: 38 (7d10) necrotic damage, and the target can’t regain hit points until the end of its next turn. Success: Half damage.
BONUS ACTIONS
Thicken Blood (Recharge 5-6). The elemental gains 10 temporary hit points. While it has these temporary hit points, its movement speed is reduced by 10 feet, but it has advantage on saving throws. The elemental can lose these temporary hit points at any time if it wishes (no action required).
Blood Elemental
Medium • Elemental • Neutral
Armor Class 14
Hit Points 91 (14d8 + 28)
Speed 30 ft., swim 60 ft.
Initiative +2 (12)
| STR | DEX | CON | INT | WIS | CHA |
|---|---|---|---|---|---|
| 12 (+1) | 14 (+2) | 14 (+2) | 8 (-1) | 12 (+1) | 8 (-1) |
Skills Perception +4
Damage Resistances acid, fire
Condition Immunities exhaustion, grappled, paralyzed, petrified, prone, restrained, unconscious
Senses darkvision 60 ft., passive Perception 14
Languages Primordial (Aquan)
CR 5 (XP 1,800; PB +3)
Blood Form. The elemental can enter an enemy's space and stop there. It can move through a space as narrow as 1 inch without expending extra movement to do so.
Blood Sense. The elemental knows the location of any creature within 100 feet that doesn’t have all its hit points. It can’t detect Constructs, Elementals, Oozes, or Undead this way.
Hemorrhagic Aura. Creatures of the elemental’s choice that don’t have all their hit points and are within a 5-foot emanation originating from the elemental lose 5 hit points due to blood loss at the start of their turn. The elemental then regains that amount of hit points. Constructs, Elementals, Oozes, and Undead are immune to this effect.
Unusual Nature. The elemental doesn't require air, food, drink, or sleep.
ACTIONS
Multiattack. The elemental makes two Sanguine Slash attacks. It can replace one of these attacks with a Blood Infusion.
Sanguine Slash. Melee Weapon Attack: +5, reach 5 feet. Hit: 15 (3d8 + 2) slashing damage.
Blood Infusion. The elemental targets a creature within 5 feet, and the target regains 13 (3d8) hit points. Then the elemental loses an equal amount of hit points. This ability can’t target Constructs, Elementals (except other blood elementals), Oozes, or Undead.
Drain. Constitution Saving Throw: DC 13, one creature that the elemental can see and that doesn’t have all its hit points within 30 feet. Failure: 27 (5d10) necrotic damage, and the target can’t regain hit points until the end of its next turn. Success: Half damage.
BONUS ACTIONS
Thicken Blood (Recharge 5-6). The elemental gains 5 temporary hit points. While it has these temporary hit points, its movement speed is reduced by 10 feet, but it has advantage on saving throws. The elemental can lose these temporary hit points at any time if it wishes (no action required).
Blood Elemental
Medium • Elemental • Neutral
Armor Class 16
Hit Points 178 (21d8 + 84)
Speed 30 ft., swim 60 ft.
Initiative +4 (14)
| STR | DEX | CON | INT | WIS | CHA |
|---|---|---|---|---|---|
| 16 (+3) | 18 (+4) | 18 (+4) | 8 (-1) | 16 (+3) | 12 (+1) |
Skills Perception +7
Damage Resistances acid, fire
Condition Immunities exhaustion, grappled, paralyzed, petrified, prone, restrained, unconscious
Senses darkvision 60 ft., passive Perception 17
Languages Primordial (Aquan)
CR 12 (XP 8,400; PB +4)
Blood Form. The elemental can enter an enemy's space and stop there. It can move through a space as narrow as 1 inch without expending extra movement to do so.
Blood Sense. The elemental knows the location of any creature within 300 feet that doesn’t have all its hit points. It can’t detect Constructs, Elementals, Oozes, or Undead this way.
Hemorrhagic Aura. Creatures of the elemental’s choice that don’t have all their hit points and are within a 15-foot emanation originating from the elemental lose 10 hit points due to blood loss at the start of their turn. The elemental then regains that amount of hit points. Constructs, Elementals, Oozes, and Undead are immune to this effect.
Unusual Nature. The elemental doesn't require air, food, drink, or sleep.
ACTIONS
Multiattack. The elemental makes two Sanguine Slash attacks. It can replace one of these attacks with a Blood Infusion.
Sanguine Slash. Melee Weapon Attack: +8, reach 5 feet. Hit: 37 (6d10 + 4) slashing damage.
Blood Infusion. The elemental targets a creature within 5 feet, and the target regains 33 (6d10) hit points. Then the elemental loses an equal amount of hit points. This ability can’t target Constructs, Elementals (except other blood elementals), Oozes, or Undead.
Drain. Constitution Saving Throw: DC 16, one creature that the elemental can see and that doesn’t have all its hit points within 30 feet. Failure: 52 (8d12) necrotic damage, and the target can’t regain hit points until the end of its next turn. Success: Half damage.
BONUS ACTIONS
Thicken Blood (Recharge 5-6). The elemental gains 15 temporary hit points. While it has these temporary hit points, its movement speed is reduced by 10 feet, but it has advantage on saving throws. The elemental can lose these temporary hit points at any time if it wishes (no action required).
QUICK REFERENCE
Habitat
- Found in cursed battlefields, blood-soaked ritual sites, and areas scarred by violent magical conflicts
- Summoned by blood mages, warlocks, or cults performing sacrificial rites
- Lurks in flooded caverns, underground rivers, or corrupted wetlands tinged with iron-rich waters or the plane of water itself
Behavior
- Moves like a churning vortex of crimson liquid, pulsing rhythmically as if mimicking a heartbeat
- Draws instinctively toward wounded creatures, circling them with predatory or solicitous curiosity; usually willing aid help for an exchange of blood
- Remains still and formless when not engaged, blending seamlessly with pools of blood or dark water
Information (Intelligence Check)
- DC 12 History: Blood elementals are sustained by nearby wounded creatures and can track spilled blood, they desire to accumulate and replace their body with fresh blood
- DC 15 Investigation: These elementals struggle to deal and interact with constructs, oozes, undead, or other elementals
- DC 18 Medicine: They have the abilities to constantly drain blood from open wounds of foes surrounding them revitalizing themselves with it
Combat
- Opens by closing the distance quickly, using its Blood Form to easily move around
- Wounds as many target as possible with Sanguine Slash to ensure that they become targets for the Hemorrhagic Aura trait or Drain ability
- Uses Drain only against foes it can't reach or that keep healing themselves
- Uses Blood Infusion early on to heal wounded allies and then regain its own hit points through its aura
- Activates Thickened Blood once it is within melee reach and no longer needs to move around much
Loot Ideas
- Hypercoagulated elemental blood useful to create high rarity healing or necrotic-resistance potions
- Blood of different races that stays fresh for unusally long periods which be used in summoning ritual or as material components
USING MONSTER VARIANTS
Monster variants allow the GM to adjust encounters to better match the party’s strength, narrative needs, or world-building logic. A weaker variant may represent a juvenile, wounded, or lesser specimen, while a stronger variant can serve as a leader, champion, ancient creature, or apex predator.
Variants can be used to fine-tune difficulty without changing the core identity of the monster, making them ideal for scaling encounters, reinforcing hierarchy within a faction, or creating memorable boss-style enemies. You can even use the same stat block but different variants in the same encounter if you want.
Design Note. Each monster is primarily balanced around its normal version. Weaker and stronger variants are derived adjustments and may not always preserve every tactical nuance or “feel” of the original creature. GMs are encouraged to review variants carefully and adjust abilities or tactics as needed to best suit their table.