You do the
Sky quest like the item page says...
The hard part is you need to loot the Blood Sky Ruby off of Eye of Veeshan. The efreeti axe probably isn't that hard to come by, bloodstained hilt is painfully common (island 7 has a very small loot table) and dulcet nectar isn't common but there's got to be a number of them floating around unused somewhere. And you need level 46.
And sadly, it isn't red. It looks like Soul Leech.