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191 is beat hush as keeper I think
http://bindingofisaacrebirth.gamepedia.com/Collection_Page#tab=Afterbirth_Complete_Collection_Grid
Real Platinium God is 100% completion without the Afterbirtch DLC, and is acheivable in the vanille game (and represents 100% completion of the Vanilla achievements and unlocks)?
See, back on Rebirth, the Lost was the only character who had a "do all marks on hard" unlock. This requirement never changed with AB and AB+, it's still "get all marks on hard", including new ones added by expansions.
Anyway, that's hardly relevant. If you have AB+ your actual end goal achievement is 1.000.000%. Any other "bunch of stuff done" achievements will be unlocked on the way.