Just out of curiosity. Could I ask why part 3 sucked? I personally found fallout 1/2 downright funny (talking to a carnivorous plant that gives you tipps how to beat a radscorpion in chess!) while I found the grey in grey world of fallout 3 simply depressing.
Bloody Mess for one would be great! But they would have to add new Death Animations ( limbs and heads flying off, blood spraying, maybe an impalment with a sword wow that would be cool)...I would actually back that with my own money, but I dont think it would happen, thats a difficult thing to do and probably time consuming and expensive, like adding new monsters.
In fact, you could just increase the amount blood produced after bloodletting/similar effects. After all, that blood can be used for various effects.