This perk can be obtained by convincing Vance to enter into a deal with the town of Arefu by passing a Speech check, a Medicine skill check, or an Intelligence check at the conclusion of the Blood Ties quest. Then, by returning to Vance and asking to be shown the ways of the vampire.
- Finishing Blood Ties by killing the Family disables chances to get this perk.
- If between finishing Blood Ties and attempting to get this perk, killing anyone in Arefu or making hostilities with Arefu or the Family, Vance will not teach this perk, and will instead call the Lone Wanderer an "asshole."
Behind the scenes
- Hematophagy is the practice found in certain animals of feeding on blood (from the Greek words, αίμα (blood) and φαγειν (to eat)).
- Its Pip-Boy icon is a reference to the character Dracula.