Test
Iron status should be checked in all patients diagnosed with RLS. A full iron assessment should include serum iron, ferritin, total iron-binding capacity, and percentage transferrin saturation, and should be measured in the early morning after an overnight fast.[23]Silber MH, Buchfuhrer MJ, Earley CJ, et al. The management of restless legs syndrome: an updated algorithm. Mayo Clin Proc. 2021 Jul;96(7):1921-37.
https://www.mayoclinicproceedings.org/article/S0025-6196(20)31489-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/34218864?tool=bestpractice.com
[27]Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018 Jan;41:27-44.
https://www.sciencedirect.com/science/article/pii/S1389945717315599
http://www.ncbi.nlm.nih.gov/pubmed/29425576?tool=bestpractice.com
Note many anemic patients do not develop RLS, and most patients with RLS do not have low ferritin levels.
Low brain iron stores have been associated with RLS. However, serum iron levels do not always correlate with central nervous system iron stores.
The cause of iron deficiency should be assessed in all patients with serum ferritin <50 nanograms/mL.[2]Winkelman JW, Armstrong MJ, Allen RP, et al. Practice guideline summary: treatment of restless legs syndrome in adults - report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2016 Dec 13;87(24):2585-93.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206998
http://www.ncbi.nlm.nih.gov/pubmed/27856776?tool=bestpractice.com
[27]Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018 Jan;41:27-44.
https://www.sciencedirect.com/science/article/pii/S1389945717315599
http://www.ncbi.nlm.nih.gov/pubmed/29425576?tool=bestpractice.com
[28]Trenkwalder C, Allen R, Högl B, et al. Comorbidities, treatment, and pathophysiology in restless legs syndrome. Lancet Neurol. 2018 Nov;17(11):994-1005.
http://www.ncbi.nlm.nih.gov/pubmed/30244828?tool=bestpractice.com