Binding of Isaac: Rebirth Wiki
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(in Afterbirth † and Repentance)

Sacrificial Altar is an unlockable activated item added in The Binding of Isaac: Afterbirth † (Booster Pack #5).

Effects[ | ]


The list of possible item rewards include:


  • If Isaac already has all of the above items, copies of Collectible Pentagram iconPentagram will replace any items spawned.
  • On use, causes a brief Curse of DarknessCurse of Darkness effect for a few seconds.
  • If Isaac has no familiars of any kind, including any temporary familiars, the item will do nothing and will not be consumed.

Notes[ | ]

Synergies[ | ]

  • (in Repentance) Collectible The Book of Belial iconThe Book of Belial + Collectible Birthright iconBirthright as Character Judas iconJudas / Character Dark Judas iconDark Judas: Grants +10.8 temporary damage up for every sacrificed familiar. The damage bonus scales down to 0 over time, similarly to Collectible Red Stew iconRed Stew. Sacrificing blue flies or blue spiders has no special effect.
  • (in Repentance)Collectible Book of Virtues iconBook of Virtues: Converts each wisp into a Half Red HeartHalf Red Heart. Spawns a single red and black wisp in the middle ring after the sacrifice.
  • (except in Repentance)Collectible Brown Nugget iconBrown Nugget: Spawned fly turrets count as familiars for sacrificing; although dropping the Brown Nugget will despawn the last fly turret, older ones will remain and can be sacrificed.
  • Collectible Cambion Conception iconCambion Conception / Collectible Immaculate Conception iconImmaculate Conception: Familiars can be sacrificed without consuming the item. The sacrificed familiars will also respawn upon entering a room.
    • (in Repentance) Spawned fly turrets count as regular blue flies for sacrificing, and thus are converted to pennies.
  • Collectible Guardian Angel iconGuardian Angel / Collectible Seraphim iconSeraphim / Collectible Sworn Protector iconSworn Protector: 2 Black Hearts will also drop.
  • (except in Repentance)Collectible Isaac's Heart iconIsaac's Heart: Can remove the Isaac's Heart familiar while the item remains, making Isaac invulnerable.
  • (in Repentance)Collectible Lemegeton iconLemegeton: Created familiars can be sacrificed. Additionally, converts each wisp into a Half Soul HeartHalf Soul Heart. The passive item effects granted by the familiars is retained for the duration of the floor.
  • (in Repentance)Collectible Plum Flute iconPlum Flute: Using Plum Flute, then using Sacrificial Altar will remove the Baby Plum spawned and spawn an item. The Plum Flute is not removed upon doing this, and subsequent usage of Plum Flute still summons Baby Plum normally.
  • (in Repentance)Collectible Quints iconQuints: The item will be lost only if Isaac has at least 1 spawned familiar in the room used, and each spawned familiar counts as one sacrifice. If Quints is sacrificed first (or is the only item available to sacrifice) and at least two familiars are summoned, two Devil Room items will be spawned while only losing one item.
  • (except in Repentance)Collectible Void iconVoid: When absorbed by Void, the one time use no longer applies, unlike other one time use active items. Familiars can be sacrificed with every activation of Void.


Interactions[ | ]

  • (except in Repentance)Collectible 7 Seals icon7 Seals: Cannot be sacrificed in itself, but Locusts can be sacrificed.
    • (in Repentance) Can now be sacrificed as usual.
  • (in Repentance)Collectible Abyss iconAbyss: Locusts created from Abyss are counted as familiars and can be sacrificed as normal.
  • Collectible Ball of Bandages iconBall of Bandages / Collectible Cube of Meat iconCube of Meat : The altar consumes the whole familiar, up to 4 cubes or balls at a time. If more than 4 are available, they count as other familiar(s) that may be separately chosen for sacrifice.
  • Collectible Best Bud iconBest Bud / Collectible Dead Bird iconDead Bird / Eve's Bird FootEve's Bird Foot / (in Repentance)Collectible Bird Cage iconBird Cage: These familiars can be sacrificed only when they're active.
  • Collectible Box of Friends iconBox of Friends / Collectible Monster Manual iconMonster Manual / Umbilical CordUmbilical Cord / (in Repentance)The TwinsThe Twins / (in Repentance)Soul of LilithSoul of Lilith: The familiars generated by these items can be sacrificed and turned into items.
  • Collectible Car Battery iconCar Battery: No effect.
  • Collectible Chaos iconChaos: The Altar ignores the effects of Chaos, always spawning items from its usual drop pool instead of a random pool.
  • (in Repentance) ConjoinedConjoined: The transformation will be lost if Isaac has less than three items needed after using Sacrificial Altar.
  • (in Repentance)Collectible Dirty Mind iconDirty Mind / (in Repentance)Dingle BerryDingle Berry: Each Dip spawned by these items or from a (in Repentance) Charming PoopCharming Poop is turned into a coin, regardless of type.
  • (in Repentance)Collectible Giant Cell iconGiant Cell: Converts all Minisaacs into one coin each.
  • Collectible Halo of Flies iconHalo of Flies: Both flies created by this item are counted as a single sacrifice each, due to the fact that they are counted as Pretty Flies. The item is taken away if either of the flies are sacrificed.
  • (in Repentance)Collectible The Intruder iconThe Intruder: The Intruder can be sacrificed even while it's in Isaac's head.
  • (except in Repentance)Collectible Lil Delirium iconLil Delirium: Lil Delirium may be sacrificed, but the item is not removed. The familiar will return once another familiar is gained or lost, or the run is quit and resumed.
  • Collectible The Pinking Shears iconThe Pinking Shears: Body familiars that are spawned by this item can be sacrificed by switching between the Pinking Shears and Sacrificial Altar. (except in Repentance) However, the body familiars reappear when picking one of the spawned items up.
  • (in Repentance)Collectible The Swarm iconThe Swarm: Each fly will be turned into a coin without consuming the item.
  • (in Repentance)Collectible Star of Bethlehem iconStar of Bethlehem: Although not readily apparent as a familiar, the Star can be sacrificed. It will be destroyed even if it is not currently in the same room.
  • (in Repentance)Collectible Sumptorium iconSumptorium / (in Repentance)Lil ClotLil Clot: Each Clot is turned into a coin, regardless of type.
  • (except in Repentance) Super BumSuper Bum: Super Bum may be sacrificed, but none of the items will be removed. The familiar will return once another familiar is gained or lost, or the run is quit and resumed.
    • (in Repentance) Super Bum may be sacrificed but only one of the items will be removed.
  • (in Repentance)Collectible Vengeful Spirit iconVengeful Spirit: Wisps will be sacrificed for one coin each.
  • Collectible Zodiac iconZodiac: The Collectible Gemini iconGemini familiar granted by Zodiac can be sacrificed without consuming the item.

No effect[ | ]

The following familiars, followers, and orbitals cannot be sacrificed:

In-game Footage[ | ]

Trivia[ | ]

Gallery[ | ]

Bugs[ | ]

Bug Bug! (except in Repentance) If used to sacrifice Collectible Succubus iconSuccubus while Isaac is in its dark aura, the damage multiplier will remain active for the remainder of the floor.


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