Blake was vacationing in Norway when Apocalypse successfully conquered America. These events prevented him from ever finding the hammer Mjolnir, as had happened on Earth-616. Finding himself in the jungles of Africa, Blake came across exchange student Gwen Stacy and nursed her back to health. Unable to return to the United States they instead participated in the relief efforts in famine-ravaged Africa.
Their relief work was terrorized by the Marauders, wealthy soldiers of fortune that would do anything for any price. They were eliminated by Tony Stark who had come seeking Donald Blake to bring his medical expertise to England. Stacy accompanied Don, not fully trusting Stark in his intentions. Blake was asked to examine human beings altered into cyborgs by the "Lost Horseman of Apocalypse", Mikhail Rasputin, who had come offering this as a final means of humanity advancing to a level on par with mutants.
This however was all a trick on Mikhail's part, who was only seeking to convert humans into obedient cyborg slaves, capturing Blake and his entourage. Expecting a double cross, the Human High Council rigged Stark's pacemaker to short-circuit the systems aboard Mikhail's ship, freeing Blake and the others. Seeing that Stark was undergoing cardiac arrest, Blake injected adrenaline directly into his heart, saving his life. While the others sabotaged the ship, Blake and Victor von Doom went to confront Mikhail who was about to order his Stryfe Force to assassinate the Human High Council. With the cyborgs incapacitated by von Doom, Blake attempted to revive one of them, but to no avail.
Confronted with Mikhail alone, Blake made the ultimate sacrifice: Despite being a man with a crippled leg, Blake was able to impale Mikhail with his walking stick and force them out of Elizabeth Tower, sending them both plunging to their deaths.