Sanguinicola Plehn, 1905 comprises 26 species that collectively infect fishes from 8 orders (Cypriniformes, Characiformes, Siluriformes, Esociformes, Salmoniformes, Labriformes, Centrarchiformes, and Perciformes). Its revision is warranted because several species assigned to the genus could represent new genera, nucleotide sequences are wanting, many species have incomplete descriptions, and types for most species are missing or of poor quality. Herein, we emend Sanguinicola based on morphology and the first nucleotide-based phylogenetic analysis that includes multiple sequences from morphologically identified adult specimens. We describe Sanguinicola plehnae Warren and Bullard n. sp. from the heart of northern pike, Esox lucius Linnaeus, 1758 from Russia; provide supplemental observations of Sanguinicola volgensis (Rašín, 1929) McIntosh, 1934 from the heart of sabrefish (type species), Pelecus cultratus (Linnaeus, 1758) Berg, 1949 from Russia; describe Sanguinicola cf. volgensis from the heart of ide, Leuciscus idus (Linnaeus, 1758) Berg, 1949 from Russia; and describe Pseudosanguinicola occidentalis (Van Cleave and Mueller, 1932) Warren and Bullard n. gen., n. comb. from the heart of walleye, Sander vitreus (Mitchill, 1818) Bailey, Latta, and Smith, 2004 from eastern North America. Sanguinicola plehnae differs from its congeners by having lateral tegumental spines that total 118-122, are small (3% of body width), and protrude 2-3 µm from the tegument (lacking associated conical protrusion) as well as by having a large testis (>40% of body length). Sanguinicola volgensis differs from its congeners by having posteriorly directed lateral tegumental spines encased in a tegumental conical protrusion as well as by having an ovoid egg. Specimens of S. cf. volgensis differ from those of S. volgensis by having a body that is 5-6× longer than wide (vs. 2-3× in S. volgensis) and <90 lateral tegumental spines (vs. >95). Pseudosanguinicola Warren and Bullard n. gen. differs from Sanguinicola by having densely transverse rows of lateral tegumental spines (vs. a single column of large spines). The phylogenetic analysis utilizing the large subunit ribosomal DNA (28S) failed to reject monophyly of Sanguinicola.