User:XT-8147/N/Mo PvE Blood Spike

Armor
Full 1.5k or 15k Scars for the extra energy and a Major Vigor rune.

Weapon
I use a collector staff with some mods on it, looks like this:
 * Hale Cruel Staff of Enchanting
 * Energy +10
 * Dark Damage: 11-22 (Requires 9 Blood Magic)
 * Halves casting time of spells (Chance: 20%)
 * Halves skill recharge of spells (Chance: 20%)
 * Health +28
 * Enchantments last 14% longer

The Hale mod isn't max simply because I haven't found a max one yet ;) The Enchanting mod isn't near max at all, but in reality the minimum Enchanting mod (10%) will allow you to recast Awaken the Blood before it ends, so salvage the first Enchanting wrap you find and chuck it on there.

For the optional slots
One of these slots will (likely) be an elite, the other won't. Elite slot:
 * Life Transfer - Adds a good amount of degen to the mix, useful for when all your spikes are recharging, also can heal you if your spikes aren't doing it well enough
 * Well of Power - Healing/Energy regen for anyone who can feasibly stand in the well. Idiot wammos will love you; character gender allowing, expect marriage proposals.
 * Blood is Power - Extra energy regen on call for anyone who needs it. Be careful using it while Awaken the Blood is active as the sacrifice will be around 50%!
 * Aura of the Lich - Decreases your sacrifices, and damage you take in general. Might want to reconsider Demonic Flesh in this case.

Non-elite slot:
 * Life Siphon - degen for them/regen for yourself, plus it's spammable so you can hit it, tab to the next enemy, and repeat.
 * Well of Blood - regen for the tanks/minions, plus the occasional back-line corpse. Ask an MM if it's ok before bringing it.
 * Blood Ritual - Extra energy regen on call for others who need it.
 * Dark Pact - More damage is always good.
 * Lifebane Strike - With Factions' duplication of some skills, we can double up on Shadow Strike ;)

Before putting either of the wells in your bar, ask any other necros if they're MMing or not, and if they are, ask if it's ok to bring the well before equipping it. With the changes to MM, they won't need every last corpse like they used to, so it should be less of a big deal.

Usage
Once outside town, activate Awaken the Blood, then Demonic Flesh. This will give you plenty of health to work with. I know, I know, everyone says "get your health down to decrease sacrifices!" but with good monks in the party it isn't really an issue (one properly-powered Word of Healing or Heal Other can replenish all the health lost, plus since you're using enchantments, Dwayna's Kiss works well to heal you), plus with all the life stealing you'll be doing with this build you'll immediately heal back most if not all of your sacrifices.

For fun, after healing to full, announce your health and see if you can confound anyone as to how you got your health that high as a necro. I did this to a PUG of 4 wammos in Sanctum Cay once, they see me go "My health is 710 of 710!" and all immediately wonder how that came to be. That was before I added the Superior Soul Reaping though.

Your spike order on a fresh target is Shadow Strike->Barbed Signet->Vampiric Gaze. If you're not being hit this will leave you at max health (remember that Awaken the Blood increases your sacrifices).

On a non-fresh target, you'll want to look at what their health bar is at, and then at the recharge status of your spikes. Most likely Vampiric Gaze will be ready or just about ready. If possible on an enemy that's still above 50%, you'll want to go for Shadow Strike first.

When dealing against Spell Breaker, Barbed Signet and your staff are your friends.

Other than that, keep Awaken the Blood and Demonic Flesh up if at all possible and adapt your use of the build to the situation you're in.