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The game takes place after a worldwide outbreak caused by a newly discovered parasite (which is heavily implied to be of alien origin). Most of humanity has been infected and turned into the “Ridden,” leaving players in a post-apocalyptic world. In this world, a group of veterans called the “Cleaners” comes together to fight off the zombies. The cleaners’ names are Walker, Holly, Hoffman, Evangelo, Karlee, Doc, Jim, and Mom.

The gameplay of Back 4 Blood is largely similar to Left 4 Dead, both are 4 player cooperative games and 8 players in a PvP mode with a focus on multiplayer and replayability. A new feature of Back 4 Blood is cards. At the start of each level, players need to build their deck with cards that adjust various elements of gameplay, such as modifying the player’s health, damage, and stamina. Along with player cards, the AI Director will also use Corruption cards against the player to hinder their progress. The AI can spawn extra enemies, activate a fog effect, and increase the size of the horde.