Table 2.

Comparison of RBC-based diagnostic measures for NAS.

Criterion	Acanthocyte count	Prolonged Erythrocyte sedimentation rate	Microfluidic assay	Ektacytometry
References	Storch et al. (2005), Darras et al. (2021), Peikert et al. (2022b)	Darras et al. (2021), Rabe et al. (2021), John et al. (2023)	Rabe et al. (2021), Recktenwald et al. (2022a), Reichel et al. (2022)	This paper
Diagnostic power	Limited (improved in automated 3D classification)	Good discrimination to controls, specificity still needs to be shown	Good discrimination to controls, specificity still needs to be shown	Discrimination at detectable limit, statistics limited to this paper
Correlation with severeness or disease state	No evidence	Unknown	Unknown	Unknown
Blood sample volume	50 μL	Typically, 1.5 mL	5 μL	200 μL
Routine devices available	Blood smear examination at different levels of automation (3D is not routine)	Several levels of automation available; parameters easy adaptable for manual devices	Yes (Erysense by Cysmic GmbH, Saarbrücken, Germany)	Yes (Lorrca by RR Mechatronics, Zwaag, The Netherlands)
Possibility of multiplexing/ throughput	Unlikely	In principle yes, but needs (software) adaptation of existing technologies	In principle yes, but needs hardware developments of existing technologies	Challenging
Implementation in clinical settings	Difficult, prone to bias, needs repeated training	Easy, though requires instrument upgrade	Medium, institution should set standard for diagnostic workup and quality control	Medium, institution should be regular user of instrument and set standard for diagnostic workup and quality control