What was the first video game to include blood

One of the first video games to ever include blood and realistic violence was Rambo for the Nintendo Entertainment System. Based off of the movie, Rambo: First Blood Part II, this game contains some of the first pixels of blood ever seen in the video game world. Rambo was released on December 4th, 1987 in Japan. North America didn't see the game until May of 1988.

The first video game to include blood and gore, realistically, was Mortal Kombat, which raised the need of the ESRB rating system due to law suits pertaining to the age level of certain video games over others. Mortal Kombat was first released for arcades in 1992, and was later made for home consoles in 1993. Mortal Kombat has since spawned numerous sequels and revamped remakes and is considered the most popular American fighting game to date.

Fun Fact: Both of theses games were published for home consoles by the Acclaim Computer and Video Game Industry.