Abstract As the incidence of myelodysplastic syndromes (MDS) increases with the ageing of the population, new and promising therapeutic approaches are being developed. “Proper application of such new strategies relies on a thorough diagnosis of these variable and pleiomorphic disorders. Cytology and cytogenetics are included in the stratification of MDS, and are the main classification criteria in two successive systems. However, the progress of multiparametric immunophenotyping and flow cytometry techniques suggest that this approach may soon become an inclusive part of the diagnostic criteria of MDS. In this review of the literature, the features of MDS and the evolution of the classification these disorders is first summarized. An extensive analysis of flow cytometry approaches, especially multiparametric, is then presented, comparing the various strategies and their output. Current information regarding immunophenotyping of MDS indicates that several anomalies in the expression of leukocyte differentiation antigens are invaluable for their diagnosis and prognosis. A more thorough and standardized comparison between normal bone marrow and MDS samples, including pattern evaluation rather than as subset enumeration, should soon further provide an efficient tool for the definition and outcome prediction of these diseases. The diagnosis of myelodysplastic disorders (MDS) currently relies on cytological features and karyotypic anomalies. These methods allow using current classifications to discriminate between the various forms of MDS. A review of the literature demonstrates that the past 5 years have seen increasing information regarding multiparametric immunophenotyping of MDS bone marrow by flow cytometry. These approaches, once standardized, should provide an additional valuable tool for the diagnosis and management of MDS patients.