They Bleed Pixels uses a simple one-button combat scheme with surprising depth at its core. Button mashing is discouraged while kicking shadowy monsters into saws, pits and spikes is rewarded thanks to a unique checkpoint earning system. Instead of being evenly distributed at set locations, players must earn and place checkpoints through stylish kills. The more stylishly you kill, the faster you fill your checkpoint meter. Avoid combat or button mash mindlessly and you’ll find checkpoints uncomfortably far apart.

When a young girl arrives at the Lafcadio Academy for Troubled Young Ladies, she's unprepared for the violent nightmares that plague her dreams and transport her to other worlds. Worse yet, her dreams are intruding into her waking life, slowly altering her flesh into the demonic form of her night terrors. Can she destroy the mysterious blood-soaked book that appears to be the root of her troubles or will her transmutation from girl to clawed horror become complete?

There's lots to do after you've completed story mode including individual level letter rankings and 150 skill based blood badges.