Mia Derleth was a native of Arhklem, citizen of Middlecreek and husband of Gerald A. Derleth. When Donald Redpath abandoned the city, Ephraim Marsh led the attack on the city. The vast majority of the citizens died in the brutal struggle. The few survivors, including Mia's husband, were turned into Reformed Ones. The female survivors were rounded up and turned into a prostitution service for the Esoteric Order's army.

When Ishmael Khalabrond and his cohorts came to Zul'Dare, Ephraim gave Mia and her daughter Asenath to them as gifts. Khalabrond freed them, but Mia angered Ephraim and was killed.

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