Myelodysplastic syndromes are clonal diseases of the hematopoietic stem cells more commonly found in the elderly. They are characterized by bone marrow failure, mainly observed through cytopenia, and an increased risk of progression to acute myeloid leukemia. A diagnosis is made by ruling out secondary causes and characterizing and quantifying the dysplasia in three hematopoietic series as well as the proportion of myeloblasts both in peripheral blood and in bone marrow. The diagnostic and prognostic role of the karyotypic and genetic abnormalities inherent to these syndromes is gaining importance, so much so that in recent years, they have been added to the most used commonly diagnostic criteria and prognostic indices. Although highly effective treatments exist, the majority of patients are older and present with sufficient comorbidity so as to prevent choosing aggressive, and therefore curative, treatment. In this scenario, correct risk stratification of the disease is essential, always taking into account the individual's baseline condition. In addition, it's important to promote the inclusion of patients in clinical trials, especially in the subgroups of patients with worse prognoses, as there is still a wide margin for therapeutic improvement.