Car Battery: No effect only spawns one item per familiar sacrificed, and can only sacrifice up to 2 familiars.Box of Friends / Monster Manual / Umbilical Cord / The Twins: The familiars generated by these items can be sacrificed and turned into items.Best Bud / Dead Bird / Eve's Bird Foot / Bird Cage: These familiars can be sacrificed only when they're active.If more than 4 are available, they count as other familiar(s) that may be separately chosen for sacrifice. Ball of Bandages / Cube of Meat : The altar consumes the whole familiar, up to 4 cubes or balls at a time.Abyss: Locusts created from Abyss are counted as familiars and can be sacrificed as normal.7 Seals: Cannot be sacrificed in itself, but Locusts can be sacrificed for one coin each, much like Blue Flies.Familiars can be sacrificed with every activation of Void. Void: When absorbed by Void, the one time use no longer applies, unlike other one time use active items.The Plum Flute is not removed upon doing this, and subsequent usage of Plum Flute still summons Baby Plum normally. Plum Flute: Using Plum Flute, then using Sacrificial Altar will remove the Baby Plum spawned and spawn an item.Monster Manual: Summoned familiars can be sacrificed since they persist for the entire floor, even without holding the item.Isaac's Heart: Can remove the Isaac's Heart familiar while the item remains, making Isaac invulnerable.Guardian Angel / Seraphim / Sworn Protector: 2 Black Hearts will also drop.Spawned fly turrets count as regular blue flies for sacrificing, and thus are converted to pennies.Brown 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.Spawns a red Wisp and a black Wisp after the sacrifice. ![]()
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