Severe, chronic anemias (such as thalassemias and sickle cell anemia) can increase the bone marrow response to form RBC's. This drive for erythropoiesis may increase the mass of marrow and lead to increase in marrow in places, such as the skull seen here, that is not normally found. Such an increase in marrow in skull may lead to "frontal bossing" or forehead prominence because of the skull shape change.