That's exactly how we got all the achievements in Fallout 3 in one run.
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That's exactly how we got all the achievements in Fallout 3 in one run. We as in, the Fallout community and achievement hunters — I'm much more of the former than the latter, but there is some crossover between the two.
There were 9 karma achievements. Reach level 8, 12 (or 14, or 16, I forget which now), and 20 (the original cap; it was raised to 30 with the Broken Steel expansion and there was a non-Karma connected achievement for hitting 30) with Bad, Neutral, or Good karma. Here's how we got all nine in one run: We'd play Evil, basically stealing everything not bolted down and whatnot. Also, playing Evil in the beginning unlocks one of the first companions you'll meet, in the first town. He won't run with you if your karma is neutral or higher. Anyway, just before hitting a requisite level, we'd make a hard save. Hit the level, pop the evil karma achievement, then reload it, go to the nearest church (there was one in Megaton, one in Rivet City, and maybe there was one other?), and donate caps by the truckload. Being evil, we had the caps (money) to do it. Pop the neutral one, then the good one... then reload that hard save and continue as evil. And then repeat the whole dog and pony show with each achievement-based level.