Walking over the spikes in a Sacrifice Room will allow you to use the IV Bag to get a few coins for free due to the brief damage invulnerability.Before getting hit by a damage that would cause a whole heart of damage (such as the maggot of a Chubber), quickly use the bag to only lose half a normal heart instead.The best application of this is probably when entering Curse rooms. Before getting hit, quickly use the bag to only lose half a normal heart instead of half a soul heart (Useful for Maggy and Eve).
From The Womb and onwards, the IV Bag can be used up to three times for each heart spent, due to the increased invincibility time from taking a full heart of damage. Quick use of the IV Bag in sequence allows for 2 uses at the price of only one half heart.Since using the IV Bag counts as the player taking normal damage, Isaac will gain a brief time of invulnerability as well.As with Blood Donation Machines, using the IV Bag will remove Eternal Hearts first, then Red Hearts up to one half heart remaining, and then finally Soul Hearts.Antibirth's artist, NotYourSagittarius, first posted a versus screen of this boss and then a full mockup in the Isaac subreddit both in January 2015, which was implemented by antibirth's developer Kilburn into a mod during the same month.Upon activation, half a heart of Isaac's current health will be depleted and a random amount of coins will spawn, and the IV can be used multiple times while only taking damage once because of the invincibility time Isaac undergoes when taking damage, allowing Isaac to use the bag two or three times before taking damage again.A third skull can be seen in the background of The Pile's boss art.
Summons waves of spikes in the cardinal directions.Pops out of the ground near the player 3 times and throws 5 bones each time.The Pile is one of the bosses that can appear in Chapter 3.
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