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Typically, only special rooms are marked on the map (item rooms, shops, arcades, bosses, deadly sins, etc.).

What's special about the blood room shown below? I tried hurting myself on the spikes, and nothing happened.

Blood room

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3 Answers

up vote 4 down vote accepted

If you damage yourself some inconsistent number of times on the spikes in the room, a chest appears.

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Pay attention that the spikes do a full heart of damage even pre-womb (never tried on womb or later), as I painfully learned by trying it with Cain. –  Kappei May 29 '12 at 7:59
    
Yes, spikes always do a full heart of damage. –  murgatroid99 May 29 '12 at 12:46
    
The spikes in this room can hurt you even when you're flying. –  disinter Jun 10 '12 at 15:43
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They are great for the nun power-up, you can get free re-rolls.

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Try using the pony power, or the book that gives you a shield, and walk over it. A chest will appear, and you won't take any damage.

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