Objective To study the combined value of Sysmex XN-20 (A1) automated hematology analyzer and blood smear. Methods 280 blood samples from June 2023 to June 2024 were selected as research objects, including 105 abnormal blood samples. Automated hematology analyzer test and blood smear test were performed, the test results were observed and analyzed, and the coincidence rate of automated hematology analyzer, blood smear test alone and combined test was calculated. Results Sysmex XN-20 (A1) automated blood cell analyzer + blood smear detected 105 abnormal blood samples, with a positive test rate of 37.50%(105/280); Sysmex XN-20 (A1) automated The blood cell analyzer detected 100 abnormal blood samples, and the test compliance rate was 35.71%(100/280); the compliance rate of Sysmex XN-20 (A1) automated hematology analyzer + blood smear test was significantly higher, but the two There is no significant difference$\left({P ={0.661},{\chi }^{2}= {0.192}}\right)$. Among the 105 abnormal blood samples, neutrophils had the highest proportion of abnormalities in 27 cases; red blood cells had the second highest proportion of abnormalities in 19 cases; lymphocytes had the third highest proportion of abnormalities in 17 cases. Conclusion The combined application of Sysmex XN-20 (A1) automated hematology analyzer and blood smear can significantly promote the improvement of the coincidence rate of blood specimen test.