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I would assume that since the crown of thorns had caused his head to bleed, his sweat was mixing with blood as it flowed off of his head.
I always took the "as it were" to be comparative: "and his sweat was as it were great drops of blood. . . ." The Greek word "ὡσεὶ" used there seems to mean "like unto".
...it has been remarked, that the word "as," or the expression, "as it were," like the corresponding Greek word, does not always signify similarity, but often reality, as in the following passages: "They counted John as a prophet"-"Their words seemed to them as idle tales"-"We beheld his glory, the glory as of the only begotten of the Father"-"We are changed into the same image, from glory to flory, even as by the Spirit of the Lord." Commentary on Luke; Vol 3; Pg 424
I am not sure what the point of the comparison would be if the sweat were not bloody. How can a drop of sweat become more bloodlike without an admixture of blood?
In my personal experience, I've sweat heavily, even to the points of drops falling, but they were kind of light-weight drops like water.
On the other hand, a few times I've had fairly bloody wounds. The blood hitting the floor pools and is sort of thick.
So I had the picture of great pools of sweat falling onto the ground around Jesus, pooling in a thick manner and reflecting what little light there was as if it were pools of blood.
Dr. Frederick Zugibe says, "Around the sweat glands, there are multiple blood vessels in a net-like form. Under the pressure of great stress the vessels constrict. Then as the anxiety passes the blood vessels dilate to the point of rupture. The blood goes into the sweat glands. As the sweat glands are producing a lot of sweat, it pushes the blood to the surface - coming out as droplets of blood mixed with sweat."
Well, whatever the drops consisted of, we know the stress was indescribably painful! It's not relevant at all whether actual blood came out. If an angel from heaven had to come to strengthen Christ's mortal body under this stress, that should tell us something of the pain of the event!