Effects of pneumatic tube transport on neurofilament light chain, neuron-specific enolase, and cardiac biomarkers

Abstract Objectives Pneumatic tube systems (PTS) accelerate clinical blood sample transport but may introduce preanalytical bias through mechanical stress and hemolysis. Effects on neurofilament light chain (NfL), neuron-specific enolase (NSE), cardiac biomarkers, and hemolysis-sensitive analytes remain incompletely defined. We assessed the impact of routine PTS transport on these analytes under controlled paired transport conditions. Methods Paired blood samples from 20 healthy volunteers were transported simultaneously by PTS or manual courier. Three-axis acceleration and temperature loggers quantified transport-associated mechanical stress and temperature exposure. NfL, NSE, cardiac biomarkers, and hemolysis-sensitive analytes were measured using routine diagnostic platforms. PTS and courier results were compared by paired analyses, and percentage bias was calculated relative to courier-transported samples. Results After Benjamini–Hochberg correction, only NfL and lactate dehydrogenase (LDH) remained significantly elevated in PTS-transported samples. Mean biases were 12.01 % (95 % CI, 7.05–16.97 %) for NfL and 10.08 % (95 % CI, 7.23–12.93 %) for LDH. NSE exhibited the largest percentage bias but did not remain statistically significant after correction. Cardiac biomarkers, including troponin-I, N-terminal pro-B-type natriuretic peptide, creatine kinase (CK), CK-MB, and high-sensitivity C-reactive protein, were not significantly affected. Potassium, bilirubin, aspartate aminotransferase, and alanine aminotransferase were likewise not significantly changed. Conclusions PTS transport significantly increased NfL and LDH concentrations, whereas cardiac biomarkers remained constant under the tested conditions. NSE showed a non-significant trend toward higher concentrations after PTS transport. These findings indicate analyte-specific vulnerability to transport-associated mechanical stress and support analyte-specific PTS route validation before routine clinical implementation.