Low ferritin in the blood - levels below about 75 - have been linked to increased severity of RLS/WED, and also to increased risk of augmentation. Augmentation happens eventually to most people who take pramipexole, and it consists of a worsening of your symptoms, caused by the very medication that is supposed to help them. Many doctors simply prescribe more of the same medication, when the real solution is usually to get off the medication completely and try something else.
Getting off the medication involves yet more agony - the augmented symptoms get even worse during the withdrawal. But after that phase, which lasts for a few days to weeks after you stop taking the pramipexole, your symptoms settle down to a much more bearable state. You might even find that you no longer have symptoms in your arms. That the intensity is less, that they don't start up until later in the day.
So getting off the pramipexole is worth every little bit of agony involved. Especially considering that staying on it just worsens the problem. The link below my name, in every post I make, will lead you to a page where you can download a number of wonderful articles on augmentation and the importance of iron stores. It would be helpful for you to read some of these, at least skim through them even if you dont understand everything, and if possible, print copies to give to your doctor.
Regarding your surgery, I would recommend - my personal, non-medical opinion - if at all possible, delay the surgery til you are no longer anemic. The loss of blood during surgery can negatively impact your iron stores and make your WED/RLS go nuts. Also, substances put in the IV can make your RLS/WED go nuts, so it's ve yvery very important to inform everyone on the surgical team
- that you have a neurological disorder that is a movement disorder
- that it is worsened by certain medications administered by IV during surgery, so you MUST not be given any of those.
The RLS Foundation has made a pamphlet for patients who have WED/RLS and need surgery to give to each member of the surgical team. See
http://willis-ekbom.org/member-portal/publications, scroll all the way down to the section called "Information for Healthcare Providers", to the very last one called Surgery and RLS. Download it and print at least 3 copies, and make sure before your surgery that the following people have a copy:
the anesthesiologist,
the surgeon,
the recovery nurse. Make sure a copy is in your chart, but also give these people a copy. The anesthesiologist is the most important one! talk to him or her about the information in the pamphlet, making sure he won't give you any of those substances that might set off the RLS, and making sure he knows that it will be dreadful for you if the RLS is set off, blood pressure might spike, and it might cause involuntary movements.
You should also get the pamphlet called called Surgery and RLS for the Patient
also perhaps Hospitalization Checklist for the Patient with RLS
We've just inundated you with lots of information, but you will find that it's your best weapon in fighting this disease. Good luck!