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Bloody Hallucinations of Guilt

 Bloody Hallucinations of Guilt
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A character cannot help but see blood on things where there is none because they feel responsible for the death of someone: they committed murder, they knowingly allowed someone to die, they tried to save a person and failed, etc.
The most common form of this trope is for the character to hallucinate blood on their hands. This comes from the saying common in English (and some other languages) "their blood is on your hands," used to tell someone that another's death is their fault. The blood of the dead and the subsequent responsibility and guilt for killing them/getting them killed is metaphorically likened to the victim's blood staining their hands. Note that there's a difference between metaphorically feeling like there's blood on your hands and actually hallucinating that there is blood on your hands; the former falls under These Hands Have Killed, though it's not uncommon for a character who simply started with just the feeling ending up with full-blown hallucinations over time.
But this has been played with numerous times over, with the amount and source of blood often reflective of the particular death the character feels guilty for. A Shell-Shocked Veteran who was Just Following Orders and participated in a genocide may hallucinate Rivers of Blood in the street or see normal people as Blood-Splattered Innocents. A murderer who buried the body in their backyard may hallucinate blood coming up from the soil. A character who accidentally killed a child may hallucinate Tears of Blood coming from the eyes of stuffed animals. And so on...
However it manifests, it's all the character's guilty conscience drudging up these images to make sure this character can never forget the death(s) they're responsible for.
A Sub-Trope of Bloody Horror and Hallucinations. Compare Guilt-Induced Nightmare, Hearing Voices, and its subtrope, Terrible Ticking, for when a sound only the character can hear drives them mad. Often preceded by My God, What Have I Done? and followed by Scrubbing Off the Trauma. Frequently a sign of Sanity Slippage and can overlap with Murder Makes You Crazy and Through the Eyes of Madness. If a character's guilt manifests in an apparition of the deceased, that's Haunting the Guilty.
Spoilers Off for character death.

Examples
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One Step Beyond (1959)
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In Fallout: Equestria, main character Littlepip discovers that the town of Arbu has been killing caravaneers, travelers, and bandits so they can eat them, even feeding them to their children. Littlepip and her group of adventurers had "dinner" with the citizens before she discovered this. The revelation is so sickening and horrifying that she breaks down and murders every pony in the village bearing a 'mark of Arbu' (which signifies they've killed and consumed a victim) — in the chaos, she might have inadvertently or purposefully killed a child as well. Afterwards, however, she's sickened and horrified with herself and how far she went, unable to see herself as anything but a monster covered in blood.
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Throughout The Suffering, Torque will routinely hallucinate his family (who by then have died, Torque in prison for it), often punctuated with the presence of bloodstains, mangled corpses and Malefactors. Whether or not Torque actually killed his wife and kids depends on the player's karma, but either way it's obvious that their deaths weigh heavy on his fragile psyche.
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Vikings: Athelstan guiltily leafs through the Bible of a monk he's killed and hallucinates that an illustrated Jesus bleeds real blood. The blood oozes onto Athelstan's hands, causing him to frantically wipe at them, but the blood has disappeared.
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Gangs of London: Following betraying and watching Sean Wallace getting shot in the season one final, Alex Dumani is dealing with this at the beginning of season two, at one point having a graphic hallucination of Sean bleeding out on the floor reaching out to him for help, representing his feelings of guilt for turning on his friend. It's partially because of this guilt (and partially the sheer stress of running the money laundering) that he decides to kill himself when The Investors catch onto his plans to escape, rather than accept Eliot's offer to fight them.
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The White Princess: After Elizabeth Woodville reappears at court, Margaret Beaufort is once more haunted by her murder of the Princes in the Tower, even hallucinating the water she's washing her hands in to be blood.
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In Crime and Punishment, Raskolnikov obsesses over cleaning up the murder of the pawnbroker. He compulsively washes the axe used to commit the deed, tries to clean off the coin purse, and stows it in the wallpaper of his room, only to later decide to just bury it somewhere. Then he realizes that he got the blood on his sock, and desperately tries to work the stain out. While the stain fades to unrecognizability, Raskolnikov is unable to not see the blood on his sock.
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Call the Midwife: Played with in one episode that features a Shell-Shocked Veteran who was traumatised by killing enemy soldiers. Rather than seeing blood that isn’t there, he can always smell blood.
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Star Trek: Deep Space Nine: In "Things Past", Odo hallucinates that his hands are covered in blood as a manifestation of his guilt for having failed to properly investigate the suspects' innocence before sentencing them to death as a constable.
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Iron Fist (2017): Ward hallucinates blood on his cuffs and flowing down an elevator shaft when he believes he has killed Harold for good.
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Wyrd Sisters: Being a Discworld take on Macbeth, it has Duke Felmet hallucinating king Verence's blood on his hands after murdering him, resorting to increasingly drastic measures to try and remove the blood including sandpaper and even a cheese grater, ensuring the blood is not always hallucinatory.
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Taiwanese psychological horror game Devotion's protaganist Du Feng-yu frequently has visions of blood on his hands, since the game is one big Guilt-Induced Nightmare over having accidently killed his daughter Mei-shin in a botched religous ritual to cure her of her mysterious illness (which, turns out, was just severe anxiety brought on by all the pressure he was putting her under). Oops.
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Macbeth: Lady Macbeth convinces her husband Lord Macbeth to kill the current king because of a prophecy that says he's to be the next king of Scotland. The ensuing murders the two have to commit to maintain their position slowly drives Lady Macbeth mad with guilt, which includes her imagining bloodstains and furiously attempting to scrub them away to no avail, culminating in her infamous line "Out damned spot!"
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M*A*S*H: Temporary replacement surgeon Steve Newsome hallucinates that he has blood all over his hands in the episode "Heal Thyself." Newsome states that no matter how much he scrubs he'll never be able to get the blood to come off. Realizing that they're in over their heads, Potter has Hawkeye and B.J. put in a call to Sidney Freedman for a psych consult.
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In Descendants of Darkness, after Hisoka has to kill Tsubaki at the end of the cruise murder mystery arc, he continues to see blood on his hands even though there is nothing there. His partner Tsuzuki comforts him.
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My Hero Academia: During the Villain Hunt Arc, Lady Nagant, in the midst of her battle against Deku, has a flashback to her time as an agent of the Hero Public Safety Commission. In truth, she was more like an assassin and enforcer and it resulted in her killing many including some who were also Heroes. One particular incident involved some kids running up to her as her fans and when she held her hand out to them, her guilty conscience hallucinated that it was drenched in the blood of those she killed, causing her to quickly recoil in shock. From then on, Nagant became increasingly disillusioned with her work for the Commission, culminating in her assassinating the President when he made a threat against her if she tried to walk away, resulting in her imprisonment in Tartarus after being falsely accused of killing another Hero.
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Yellowjackets: the plane crash survivors have to deal with having eaten one of their own, among other things. In "Digestif" the adult Lottie goes to check the apiaries in the "intentional community"/cult compound and finds one covered in dead bees. Inside, the frame is all bloody. For added points of horror she hears the same words she uttered during the séance, "He/It wants blood" in French. It's all just visions.
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In Only God Forgives, Julian is given to sullenly staring at his hands and watching them slowly turn into fists. At one point he washes his hands, but he sees the water become blood. This is implied to be guilt over having beaten his father to death.
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Spartacus: Blood and Sand: During Numerius' birthday celebration at the ludus, some of the women begin talking about the recently-missing Licinia, causing Ilithyia to hallucinate a pool of blood under her feet and Licinia's bloodied, disfigured corpse lying on the spot where Ilithyia had murdered her in a violent rage.
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7 Days (2021): Three friends, Ray, Callum, and Rosie, hang out in the woods drinking when Ray accidentally kills Rosie. Ray forces Callum to help him dump the body and lie to the police to cover it all up. Later on, Callum at one point hallucinates that he's got blood on his hands.
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You (2018): During an acid trip in season 2, Joe keeps seeing blood all over his hands as a manifestation of his repressed guilt for having killed Beck last season.
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At the end of the Batman (Tom King) storyline "The Gift", Booster Gold, who created a world where Bruce Wayne's parents weren't killed in a misguided attempt to help Bruce come to terms with it, For the Man Who Has Everything style, finds himself with the alternate Bruce in a certain alley in Gotham thirty years ago. When the alternate Bruce (who had already seen Thomas and Martha in his own timeline die) sees what happens, he shoots himself, and Booster gets splattered with blood. We then cut to him confessing what he's done to Batman, and he says there's a speck of blood on his goggles that just won't come off. "You see it too, right?" The goggles are immaculate.
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