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Blood is life. Through blood, all things both good and bad are transported throughout the body. Within blood lies power and some medics learn to tap into and manipulate that power to both heal and harm.

Barefisted Syringe (Ex): The sanguinist loves to get her hands dirty, and drawing blood with her bare hands brings forth the power much quicker and easier than other methods. At 1st level, the sanguinist gains Improved Unarmed Strike as a bonus feat, even if she does not meet the prerequisites. At 3rd level, she gains Greater Unarmed Strike as a bonus feat, even if she does not meet the prerequisites, and uses her medic initiator level in place of her base attack bonus for determining the damage of her unarmed strikes. In addition, the sanguinist may choose to deal bludgeoning, piercing or slashing damage with her unarmed strikes. This ability replaces one of her medic’s expertises gained at 1st level.

Blood Reserve (Su): At 1st level, the sanguinist gains the ability to store the vitality of others within her body. Whenever the sanguinist uses her blood transfusion ability to deal additional damage, that extra damage is stored as hit points in her blood reserve. Whenever the sanguinist uses triage to heal an ally, the sanguinist draws those hit points from her blood reserve instead of providing the normal amount of healing from triage. When using triage, the sanguinist can heal a number of hit points up to the total amount currently in her blood reserve, however she may determine the exact amount healed at the time she uses her triage. These hit points are then deducted from the total amount of hit points in the blood reserve.

For example, if a 1st level sanguinist has 20 hit points in her blood reserve, when she uses triage on an ally, and she heals that ally for 20 hit points, she would reduce her blood reserve to 0. She may instead choose to heal the ally for a lesser amount, such as 10 hit points, leaving the remaining amount in her blood reserve for later use. The blood reserve can only store hit points for up to 24 hours, but it does not have a maximum number of hit points it can store. This alters the medic’s triage ability.

Blood Transfusion (Su): Starting at 1st level, the sanguinist gains the ability to drain the lifeblood of a creature, store that vitality and transfer it elsewhere. Whenever the sanguinist deals lethal damage with an unarmed strike or natural attack, she deals additional damage equal to her initiation modifier. This additional damage represents lifeblood or some other form of vitality stolen from the target of her attack, which is then stored in the sanguinist's blood reserve as an equivalent number of hit points in order to fuel her ability to heal. In addition, any unarmed strike or natural attack modified by her blood transfusion ability is treated as a magic weapon. If the target’s current hit points are less than the sanguinist’s initiation modifier, she cannot transfer that additional damage to her blood reserve as healing.

Pain’s Gain (Ex): The sanguinist knows how to put her instinct to cause harm to good use. Starting at 3rd level, the sanguinist gains a +1 bonus to attack and damage rolls made with natural attacks or unarmed strikes. This bonus increases by +1 at 7th level and every four levels thereafter. This ability replaces cura te ipsum.

Unnatural Vitality (Su): At 4th level, the sanguinist becomes immune to all poisons and diseases. Whenever the sanguinist uses her blood transfusion or triage ability, she may choose to absorb any poison or disease currently affecting the target. The target is immediately cured of that affliction, and the sanguinist may choose to the poison or disease within the sanguinist’s blood reserve. If the sanguinist has a poison or disease stored in her blood reserve which deals only ability score damage (with no additional effects such as unconsciousness, paralysis or sleep), she may choose to inflict it upon the target of her blood transfusion or triage. The target must succeed on a Fortitude save (DC 10 + 1/2 the sanguinist's class level + the sanguinist's initiation modifier) or be subject to the disease/poison’s effects as if they had failed their save against that poison or disease. If the disease or poison would have an onset that is not immediate, treat the onset as if it were immediate. The sanguinist cannot store more diseases or poisons than her initiation modifier at any given time, however these remain in the blood reserve until used, unlike hit points. This ability replaces the medic’s expertise gained at 4th level.

Feast of Blood (Su): At 20th level, the sanguinist increases the amount of hit points she drains from a target of her unarmed strike or natural attack by 50%. This ability replaces master medic.