In Elden Ring, the Rivers of Blood weapon causes Hemorrhage.
Rivers of Blood is a unique katana associated with the Bloody Finger Okina. Its Corpse Piler skill performs a series of blood-soaked slashes that build the Hemorrhage status effect rapidly. When the buildup bar is filled, Hemorrhage causes a large burst of damage based partly on the target’s maximum health.
The katana requires Dexterity and Arcane, with some Strength, and is obtained from Bloody Finger Okina near the Church of Repose in the Mountaintops of the Giants. It cannot be infused with a different Ash of War because its weapon skill is fixed.
Hemorrhage is often called “bleed” by players, but Hemorrhage is the game’s formal status name. It is distinct from Scarlet Rot, Poison, and Frostbite, which use different buildup and damage rules. The weapon’s red visual effects do not mean it inflicts Scarlet Rot.