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There is about 0.658% chance for Monstro to spawn with 4 Ministros. This is the same chance for him to spawn with 2 Blood Donation Machines : r/bindingofisaac
Keeper (The Binding Of Isaac) | Know Your Meme
Blood compatibility testing - Wikipedia
the binding of isaac wrath of the lamb - Is there anything special about the blood rooms? - Arqade