Haha, that's one of the easiest tricks to do. What you do to make the illusion of piercing the skin is bending your fingers under your palm, so it looks as if they went through the skin. The blood is in a prepackaged bag, which he pops at the right time. And as previously mentioned, watch his shirt, the fake heart is under it. The way he does this magic trick is the same way those fake doctors would "pull" the cancer from your stomach in the Philippines, or elsewhere in the world.