Blood Form. The elemental can enter a hostile creature's space and stop there. It can move through a space as narrow as 1 inch wide without squeezing.
Sickening Presence. Each creature that is within 120 feet of the elemental and aware of it must succeed on a DC 16 Constitution saving throw or become poisoned for 1 minute. A creature can repeat the saving throw at the end of each of its turns, ending the effect on itself on a success. If a creature's saving throw is successful or the effect ends for it, the creature is immune to the elemental's Sickening Presence for the next 24 hours.
Multiattack. The elemental uses Leeching Tendril four times and uses Leech twice.
Leeching Tendril. Melee Weapon Attack: +9 to hit, reach 5 ft., one target. Hit: 14 (2d8 + 5) piercing damage. The target is grappled. Until this grapple ends, the target is restrained. The elemental has six Leeching Tendrils, each of which can grapple one target.
Leech. Melee Weapon Attack: +9 to hit, reach 5 ft., one target. Hit: 12 (2d6 + 5) piercing damage, plus 7 (2d6) necrotic damage. The target's hit point maximum is reduced by an amount equal to the necrotic damage taken, and the elemental regains hit points equal to that amount. The reduction lasts until the target finishes a long rest. The target dies if this effect reduces its hit point maximum to 0.
Blood Rain (Recharge 4-6). The elemental causes blood to rain from above in a 20-foot radius, 40-foot high cylinder centered on a point within 300 feet. Each creature in the cylinder must make a DC 16 Dexterity saving throw, taking 22 (5d8) necrotic damage and falling prone on a failed save, or half as much damage and avoiding falling prone on a successful one. The area of the blood rain is considered lightly obscured. The blood rain lasts for 1d3 rounds. If the elemental uses its Blood Rain attack again, the original cylinder dissipates and is replaced with the new one.
Blood Absorption. When the elemental kills a creature with a vascular system it immediately absorbs its blood. The elemental gains 20 temporary hit points, and its size increases to Huge. While Huge, its attacks deal 1 extra damage die of their damage type.
Description
Blood elementals are often the result of ritual sacrifices pooling together the blood of humanoids. Blood elementals may also be spawned chaotically out of the pooled blood of mass battles or massacres or when the blood of a massive magical creature (such as a dragon) is spilled. Some powerful blood mages are also able to summon these disgusting elementals.
Elemental Nature. An elemental does not require air, food, drink, or sleep.
Evil Creation. Blood elementals are difficult to bind for long periods of time and are usually only created on the Material plane as a way of getting revenge on someone else, summoning the elemental somewhere close by where its thirst for blood will create the most havoc.
Native to the Material. Blood elementals are unique in elementals in that their home plane is considered to be whatever plane they are created on, not one of the elemental planes beyond that sphere. In addition, unlike most elementals that take on bodiless forms on their home plane, blood elementals retain their shape on their home plane.
Thirsty. These disgusting elementals are composed entirely of blood and desire nothing other than to absorb more blood, growing their physical forms and enhancing their power. Some believe a blood elemental that absorbed enough blood could grow to gargantuan size and likely wipe out settlements.
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