Acute Hemorrhagic Sicaremia Condition in Imperia Triplica | World Anvil

Acute Hemorrhagic Sicaremia

That’s the thing about sicara poison:
no one realizes they’ve breathed their last breath
until they try to take the next one.
— Praetor Octavius Caelius Deceangius


Acute Hemorrhagic Sicaremia (AHS) is the name for the syndrome that manifests in the majority of people who come into mucosal contact with the sicara poison of the Sicarii assassins.

Transmission & Vectors

Mucosal contact with the sicara poison. This is usually ingested with food or drink. Some of the Sicarii choose to lace a blade with sicara poison and stab their victim. This does not generally lead to a systemic poison effect like ingestion does, but rather will result in Acute Localized Hemorrhagic Sicaremia (ALHS). This is not as deadly as AHS, due to ALHS being more localized and is able to be isolated. A single failing organ can be removed more easily than systemic hemorrhage.


Caused by the sicara poison, the chemical of choice of the Sicarii assassins. Sicara poison acts on the clotting cascade, at first causing widespread and uncontrolled clotting, which uses up all clotting factor and leads to an inability to clot. The victim becomes hemorrhagic, bleeding out in a matter of hours if not given massive blood transfusions. Even in that case, recovery is not likely, with only 5% of people hospitalized with AHS making a recovery beyond 6 months from poisoning.


  • widespread clotting, followed by exhaustion of clotting cascade and inability to clot
  • purplish spotted rash on the skin
  • acute renal failure
  • liver failure
  • uncontrollable bleeding from the mucous membranes
  • bruising
  • mental confusion
  • respiratory distress
  • frothy pink or red sputum
  • frank hemoptysis
  • frank hematemasis
  • grainy black vomit or clotted vomit
  • melena
  • bulging of the eyes (exophthalmos)
  • protrusion of the brain from the skull


There is no cure or reversal agent. The only treatment is supportive care with IV fluids and blood transfusions, and even these are a gamble in most people afflicted by the condition.


Poor. The majority of people with AHS will succumb to their illness. Even those who survive the initial disease are often taken down weeks to months later by an unrelated injury or illness. There are stories in medical schools of patients who survived the horrors of AHS only to bleed to death due to a hangnail three months later.


The lasting effects of AHS are themselves often deadly, with chronic fatigue, weakness, and continued clotting and/or bleeding disorders the most common lasting effects. Often these effects continue until the person's death. A person who survived an AHS episode has sharply decreased chances of surviving any other illness or injury.

Some of the most common sequelae of AHS are:
  • weakness
  • fatigue
  • mental confusion
  • shortness of breath on exertion
  • continued clotting or bleeding


There is no prophylactic care for sicara poison, nor is there any way to develop a tolerance for the poison. The Imperia spent years wiping out the plant the toxin is derived from, hemflos. However, as this flower is sacred on its native Deceangia and revered by the Cult of Saint Ulia, clandestine efforts to preserve the sacred flower were successful.


The striking hemflos flower lives in Deceangian legend as responsible for one of the planet's most infamous massacres, as told by the historian Bricius in the Archives of the Deceangian Eras. In this tale, Bricius tells of Saint Ulia, a princess whose husband was murdered by being force-fed hemflos and being left to hemorrhage to death. Ulia exacted her terrible revenge upon her husband's assassins, turning the poison on them and their entire nation.
Hemflos flowers

Unfortunately, the Sicarii assassins developed a poison from the compounds of the sacred hemflos. They used this poison to lace sicara daggers and make stabbings more severe. When the poison was used on members of the Senate during The Night of Bitter Words, the flowers were wiped out by the Imperia to prevent further poisonings. The remaining sicara poison became coveted, and was saved for only the Sicarii's most high-value targets.

Chemical Compound
Affected Species


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