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Unable to use Red Hearts as health. She instead uses them as blood charges, as an alternative to charging active items. Any item that gives Red Heart containers will grant a Soul Heart instead.
Blood charges are displayed on the HUD and operate at the rate of 1 blood charge per half red heart. Bethany starts with 6 blood charges.
Blood charges can be used to use an active item without having enough regular charges to do so. This is displayed by the item bar having red instead of green charges. The amount of red charges is equal to how many blood charges are going to be consumed if the item is used.