The game follows a Hunter through the decrepit Gothic, Victorian-era–inspired city of Yharnam, whose inhabitants are afflicted with a blood-borne disease which transforms the residents, called Yharnamites, into horrific beasts.

Attempting to find the source of the plague, the player's character unravels the city's mysteries while fighting beasts and cosmic beings.

Players battle varied enemies while using items such as trick weapons and firearms, exploring different locations, interacting with non-player characters, and unraveling the city's mysteries.

Bearing many similarities to FromSoftware's Dark Souls series, Bloodborne was inspired by the literary works of authors H. P. Lovecraft and Bram Stoker, as well as the architectural design of real-world locations in countries such as Romania and the Czech Republic.

Bloodborne is an action role-playing game played from a third-person perspective and features elements similar to those found in the Dark Souls series, also made by FromSoftware.

The new risk-and-reward style of gameplay is emphasized through Bloodborne's Rally system, which allows the player to recover portions of lost health by striking an enemy within a small window of time after taking damage.

Long ago, ruins of an ancient civilization were found underneath the city, prompting an investigation by the College of Byrgenwerth, an institution studying human transcendence.

The excursion unearthed the existence of eldritch beings called Great Ones, who had ascended their consciousnesses to a higher plane, and a substance known as Old Blood, which could cure any illness.

However, college head Willem forbade using the Blood in their transcendence research, fearing it would turn imbibers into the beasts that destroyed the ancient civilization.

Following the closing of the Hunters Workshop, its founder, Gehrman, lacked purpose and sought contact with the Great Ones, and one known only as the Moon Presence answered.

Rom's death allows the Hunter to perceive a vision of Queen Yharnam, an ancient being from the dead Pthumerian civilization who supposedly bore Mergo, the source of the Nightmare.

They eventually make their way to a research hall, inhabited by people who have been experimented on, and a clock tower, where they encounter Maria – one of the original hunters under Gehrman who guards the Nightmare's innermost reaches.

Continuing through the village, the Hunter makes their way to the beach where they discover the Nightmare's source: Kos’ postmortem-born child.

After being defeated and laid to rest, however, the creature's phantom returns to its mother's side, ending the Hunter's Nightmare.

There were no connections to FromSoftware's previous titles, even though Miyazaki conceded that it "carries the DNA of Demon's Souls and its very specific level design".

[42] The game's Victorian Gothic setting was partly inspired by the novel Dracula,[43] and the architecture of locations in Romania and the Czech Republic.

[44] Miyazaki also enjoyed H. P. Lovecraft's Cthulhu Mythos series of surreal horror stories, and applied similar themes into the game.

Because it would fit well into the game's setting, and that it would consequently be less accurate than modern models, guns were eventually included, taking the place of shields from the previous Souls titles.

The soundtrack contains over 80 minutes of original music by Tsukasa Saitoh, Yuka Kitamura, Nobuyoshi Suzuki, Ryan Amon, Cris Velasco and Michael Wandmacher and features performances by a 65-piece orchestra and a 32-member choir.

[53] However, Miyazaki later stated that Bloodborne was never considered to be Demon's Souls II, due to Sony Computer Entertainment wanting a new intellectual property (IP) for the PlayStation 4.

He also praised its challenging gameplay, which he compared to the Dark Souls series, as well as its intimately-realized story, high replay value, deliberate, rewarding and fast-paced combat, sparse storytelling and satisfying weapon customization.

He summarized the review by saying that "While this new IP doesn't stray far from the established Souls franchise, it is a magical, wondrous work that admirably instills both terror and triumph in those brave enough to delve into it.

"[74] Kevin VanOrd of GameSpot praised its Lovecraftian horror-themed storyline, energetic boss battles, precise combat for making encounters with enemies fun, as well as its unique artistry and varied environments.

He also praised the sound design of the enemies, the difficulty, which he compared to Dark Souls II, and the melee-based weapons featured in the game for allowing transformation during battle.

However, he criticized the game's non-divergent class system, as well as the specialization, as he stated that "lack of magic, miracles, pyromancy, archery, heavy, medium, and light options discourages experimentation."

"[75] IGN's Brandin Tyrrel wrote that Bloodborne was "an amazing, exacting, and exhausting pilgrimage through a gorgeous land that imposes the feeling of approaching the bottom of a descent into madness.

He summarized the review by saying that "Though not as refined and freeform as some of its predecessors, it continues in the longstanding Souls tradition of lending credence to challenging games and making the seemingly Sisyphean task of conquering ruthless, malformed monstrosities possible and downright commendable.

[81] New York Daily News stated that it was "the perfect marriage, blending mechanics that seem easy to learn with gameplay and challenge that demands mastery and ingenuity.

"[82] The Guardian also gave it a full five-star rating, stating that "elegance, precision, humor, and challenge make Bloodborne irresistible.

"[83] The Telegraph wrote that it was the "digital edition of a round-the-world trip to foreign continents, each turning of a corner providing equal helpings of excitement and trepidation".